Schofield Penelope, Jefford Michael, Carey Mariko, Thomson Kathryn, Evans Melanie, Baravelli Carl, Aranda Sanchia
Supportive Care Research Group, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, Victoria 8006, Australia.
Support Care Cancer. 2008 Jan;16(1):37-45. doi: 10.1007/s00520-007-0273-4. Epub 2007 May 30.
Based on meta-analyses regarding the preparation of patients for potentially threatening medical procedures, a DVD, incorporating behavioral role modelling, was developed to prepare patients for chemotherapy and assist them to self-manage side effects. It was hypothesized that patients who watched the DVD (vs those who did not) would report (1) lower anxiety; (2) higher self-efficacy related to coping with treatment side effects; (3) fewer supportive care needs; and (4) higher satisfaction with information received. It was further hypothesized that these effects would be stronger in those perceiving their treatment intent to be curative rather than palliative.
Quasi-experimental design using a historical control group was employed. Participants were scheduled to receive their first ever chemotherapy treatment. Group 1 (usual care; n = 50) was prospectively recruited before the release of the DVD and group 2 (DVD plus usual care; n = 50) after the release. Before commencing chemotherapy, all patients completed reliable and valid measures of self-efficacy, anxiety, and supportive care needs. Data was stratified according to perceived treatment intent. Independent sample t tests were performed for each group (curative vs palliative).
Significant differences were found between the usual care and intervention groups: for self-perceived curative patients in relation to self-efficacy for seeking social support (p = 0.044), with increased confidence in those watching the DVD, and for self-perceived palliative patients in relation to their satisfaction with information about side effects (p = 0.026), with increased satisfaction in those watching the DVD. Overall, significant differences were found between self-perceived curative vs palliative patients on measures of self-efficacy and supportive care needs, with self-perceived curative patients reporting more confidence and fewer needs.
The educational DVD was considered highly acceptable by patients and was found to increase self-efficacy and reduce supportive care needs. Hence, it is appropriate to give to patients before face-to-face chemotherapy education. Additional pretreatment education is recommended, particularly for self-perceived palliative patients, to reduce their pretreatment anxiety and enhance their confidence in coping with treatment.
基于对患者进行可能具有威胁性的医疗程序准备工作的荟萃分析，制作了一张包含行为榜样示范的DVD，用于帮助患者为化疗做好准备，并协助他们自我管理副作用。研究假设观看DVD的患者（与未观看者相比）会报告：（1）焦虑程度更低；（2）应对治疗副作用的自我效能感更高；（3）支持性护理需求更少；（4）对所获信息的满意度更高。进一步假设这些效果在认为治疗目的是治愈而非姑息治疗的患者中会更强。
采用历史对照组的准实验设计。参与者计划接受首次化疗治疗。第1组（常规护理；n = 50）在DVD发行前前瞻性招募，第2组（DVD加常规护理；n = 50）在发行后招募。在开始化疗前，所有患者完成了关于自我效能感、焦虑和支持性护理需求的可靠且有效的测量。数据根据感知到的治疗目的进行分层。对每组（治愈性治疗与姑息性治疗）进行独立样本t检验。
在常规护理组和干预组之间发现了显著差异：对于自我认为是治愈性治疗的患者，在寻求社会支持的自我效能感方面（p = 0.044），观看DVD的患者信心增强；对于自我认为是姑息性治疗的患者，在对副作用信息的满意度方面（p = 0.026），观看DVD的患者满意度提高。总体而言，在自我效能感和支持性护理需求的测量方面，自我认为是治愈性治疗与姑息性治疗的患者之间存在显著差异，自我认为是治愈性治疗的患者报告的信心更强且需求更少。
患者认为该教育DVD非常可接受，并且发现它能提高自我效能感并减少支持性护理需求。因此，在进行面对面化疗教育之前将其提供给患者是合适的。建议进行额外的预处理教育，特别是针对自我认为是姑息性治疗的患者，以减轻他们的预处理焦虑并增强他们应对治疗的信心。
