Fukui Sakiko, Ogawa Keiko, Ohtsuka Masao, Fukui Naoshi
School of Nursing, Chiba University, Chiba, Japan.
Cancer. 2008 Sep 15;113(6):1462-70. doi: 10.1002/cncr.23710.
Although studies have shown the usefulness of improving health professionals' communication skills by training, to the authors' knowledge none have demonstrated the efficacy of communication skill training (CST) for health professionals in terms of improving patient outcomes. This study aimed to assess the efficacy of CST for nurses in improving psychologic distress and coping among patients after being informed of a cancer diagnosis.
Nurses who mainly provide patients with psychologic and informational support after being informed of their cancer diagnosis by physicians at a cancer screening center were randomly assigned to either an experimental or a control group; patients were supported by either group of nurses. Patient selection criteria were: age >18 years with gastric, colorectal, or breast cancer that was not in advanced stage. Intervention consisted of 3 1-on-1 nurses' interviews (on the day of, 1 week after, and 1 month after diagnosis). Efficacy was assessed through patients' psychologic distress and coping by administering the Hospital Anxiety and Depression Scale (HADS) and Mental Adjustment to Cancer scale (MAC), at 3 time points (1 week, 1 month, and 3 months after diagnosis).
Eighty-nine patients participated. Repeated measures analysis of variance demonstrated a significant group-by-time decrease in patients' psychologic distress on HADS (P = .03), and significant group-by-time increase in fighting spirit and decrease of fatalism (P = .01 and P = .04, respectively), in addition to significant between-group difference of anxious preoccupation on the MAC (P = .003).
Support by nurses who completed the CST program was found to reduce psychologic distress and improved coping long term among patients informed of their cancer diagnosis.
尽管研究表明通过培训可提高医护人员的沟通技巧,但据作者所知,尚无研究证明沟通技巧培训(CST)对医护人员改善患者治疗效果的有效性。本研究旨在评估CST对护士在改善癌症诊断告知后患者心理困扰及应对能力方面的有效性。
在癌症筛查中心,由医生告知癌症诊断后主要为患者提供心理和信息支持的护士被随机分为实验组或对照组;患者由其中一组护士提供支持。患者入选标准为:年龄>18岁,患有非晚期胃癌、结直肠癌或乳腺癌。干预措施包括3次一对一护士访谈(诊断当天、诊断后1周和1个月)。通过在3个时间点(诊断后1周、1个月和3个月)使用医院焦虑抑郁量表(HADS)和癌症心理适应量表(MAC)评估患者的心理困扰和应对能力来评估有效性。
89名患者参与研究。重复测量方差分析显示,HADS量表上患者的心理困扰有显著的组×时间下降(P = 0.03),战斗精神有显著的组×时间增加且宿命论有显著下降(分别为P = 0.01和P = 0.04),此外MAC量表上焦虑专注方面存在显著的组间差异(P = 0.003)。
研究发现,由完成CST项目的护士提供支持可减轻告知癌症诊断的患者的心理困扰并长期改善其应对能力。