Hollen P J, Hobbie W L, Finley S M
School of Nursing, Northeastern University, Boston, MA, USA.
Oncol Nurs Forum. 1999 Oct;26(9):1475-86.
PURPOSE/OBJECTIVES: To test the effects of a decision-making and risk-reduction program for cancer-surviving adolescents.
Prospective clinical trial using a quasi-experimental pretest/post-test design with repeated measures.
Two survivor follow-up clinics and a camp for children and adolescents with cancer located in upstate New York.
A convenience sample of 64 survivors (13-21 years of age). The intervention group consisted of 21 survivors who attended a workshop, and the comparison group consisted of 43 survivors who did not attend the workshop.
Intervention-integrated information specific to survivorship, decision-making skills, risk behaviors, and social support from peers and healthcare professionals. The educational component of the program lasted one day (five one-hour units), and the social component lasted overnight. A single, semistructured interview at the time of the previous yearly evaluation visit was used for baseline data. Testing was conducted during home visits at 1, 6, and 12 months.
Decision making, risk motivation, and risk behaviors (i.e., smoking, alcohol use, and illicit drug use).
The effect of the intervention for improving decision making was significant at 1-month postintervention, marginally significant at 6-months postintervention, and highly significant at 12-months postintervention. The effect of the intervention for motivation toward alcohol use was significant at 1-month postintervention and marginally significant at 6-months postintervention; however, the intervention had no effect on smoking motivation at any of the three time intervals. The effect of the intervention for improving smoking behavior was marginally significant at 6-months postintervention and was marginally significant at 12-months postintervention for alcohol use.
The intervention had a dampening effect on the upward trajectory of substance use, a path that is well-known to increase with age for both genders in the general population. This short, five-hour program for improving decision making and affecting substance use of teen survivors shows promise; however, a larger sample is needed to enhance findings.
Besides tailoring risk-behavior information based on actual or potential late effects of treatment to each teen survivor during follow-up visits, oncology professionals need to provide booster programs to refine decision-making skills within meaningful decision context for teen survivors as a means of reducing risk behaviors.
目的/目标：测试一项针对癌症幸存青少年的决策与风险降低项目的效果。
采用准实验性前测/后测设计并重复测量的前瞻性临床试验。
位于纽约州北部的两家幸存者随访诊所及一个针对患癌儿童和青少年的营地。
64名幸存者（13至21岁）的便利样本。干预组由21名参加工作坊的幸存者组成，对照组由43名未参加工作坊的幸存者组成。
干预整合了特定于幸存者身份、决策技能、风险行为以及来自同伴和医疗保健专业人员的社会支持等信息。该项目的教育部分持续一天（五个一小时单元），社会部分持续一整晚。在之前年度评估访问时进行一次半结构化访谈以获取基线数据。在1个月、6个月和12个月进行家访测试。
决策、风险动机和风险行为（即吸烟、饮酒和非法药物使用）。
干预对改善决策的效果在干预后1个月显著，在干预后6个月边缘显著，在干预后12个月高度显著。干预对饮酒动机的影响在干预后1个月显著，在干预后6个月边缘显著；然而，干预在三个时间间隔中的任何一个对吸烟动机均无影响。干预对改善吸烟行为的效果在干预后6个月边缘显著，对饮酒行为在干预后12个月边缘显著。
该干预对物质使用的上升轨迹有抑制作用，而在一般人群中，这条轨迹是众所周知的会随年龄增长而上升，且男女皆是如此。这个为期五小时的旨在改善决策并影响青少年幸存者物质使用的简短项目显示出了前景；然而，需要更大的样本量来强化研究结果。
除了在随访期间根据治疗的实际或潜在晚期效应为每位青少年幸存者量身定制风险行为信息外，肿瘤学专业人员还需要提供强化项目，以便在有意义的决策背景下提升青少年幸存者的决策技能，以此作为降低风险行为的一种手段。
