McLean Linda M, Jones Jennifer M, Rydall Anne C, Walsh Andrew, Esplen Mary Jane, Zimmermann Camilla, Rodin Gary M
Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
Psychooncology. 2008 Nov;17(11):1152-6. doi: 10.1002/pon.1319.
The primary objective of this study was to evaluate the effectiveness of a couples intervention in improving marital functioning in advanced cancer patients and their spouse caregivers. A secondary objective was to determine its impact on other symptoms of psychosocial distress and its feasibility and acceptability as a clinical intervention.
Using a one-arm pre- and post-intervention prospective design, 16 couples were provided 8 weekly sessions of Emotionally Focused Couple Therapy, modified and manualized for the cancer population. Subjects' marital functioning (Revised Dyadic Adjustment Scale [RDAS]), symptoms of depression (Beck Depression Inventory-II [BDI-II]), and hopelessness (Beck Hopelessness Scale) were assessed through self-report at T0 (baseline), T1 (after four sessions), T2 (after eight sessions), and T3 (3 months post-intervention follow-up).
RDAS scores improved from T0 to T2, with 87.5% of the couples showing some improvement (0.5-5 points) or significant improvement (>5 points) in marital functioning and 68.8% scoring in the non-distressed range (>or=48 RDAS). At T3, 60% of the couples (n=15) continued to score in the non-distressed range on the RDAS. BDI-II scores were significantly higher for patients than for caregivers. There was a significant reduction in the mean BDI-II score from T0 to T3 in all subjects (n=30). This reduction was more significant for the patients (n=15).
Providing support to couples at this challenging time may result in improved marital functioning and an opportunity for relational growth during end-stage cancer. This study serves as the first step in the development of an empirically validated intervention for couples.
本研究的主要目的是评估一种夫妻干预措施对改善晚期癌症患者及其配偶照顾者婚姻功能的有效性。次要目的是确定其对其他心理社会困扰症状的影响，以及作为一种临床干预措施的可行性和可接受性。
采用单组干预前后前瞻性设计，为16对夫妻提供了8次每周一次的情感聚焦夫妻治疗，该治疗针对癌症患者群体进行了修改并形成手册。通过在T0（基线）、T1（四次治疗后）、T2（八次治疗后）和T3（干预后3个月随访）时的自我报告，评估受试者的婚姻功能（修订的二元调整量表[RDAS]）、抑郁症状（贝克抑郁量表第二版[BDI-II]）和绝望感（贝克绝望量表）。
RDAS评分从T0到T2有所改善，87.5%的夫妻在婚姻功能上有一定改善（0.5 - 5分）或显著改善（>5分），68.8%的夫妻在非困扰范围内得分（RDAS≥48分）。在T3时，60%的夫妻（n = 15）在RDAS上继续在非困扰范围内得分。患者的BDI-II评分显著高于照顾者。所有受试者（n = 30）的平均BDI-II评分从T0到T3有显著降低。这种降低在患者（n = 15）中更为显著。
在这个具有挑战性的时期为夫妻提供支持可能会改善婚姻功能，并为晚期癌症期间的关系发展创造机会。本研究是为夫妻开发经实证验证的干预措施的第一步。
