Kost Christiane, Labouvie Hildegard, Kosfelder Joachim, Höhl Ulrich, Herrmann-Lingen Christoph, Kusch Michael
Ruhr-Universität Bochum, Institut für Gesundheitsförderung und Versorgungsforschung gGmbH, Bochum.
Psychother Psychosom Med Psychol. 2009 Dec;59(12):432-9. doi: 10.1055/s-2008-1067575. Epub 2008 Nov 10.
The aim of this health service research study was to investigate the change in the psychological distress of cancer in-patients. According to the structured psychooncological care program Case Management Psychoonkologie (CMP) the patients received psychological treatment during the acute cancer therapy. The CMP was implemented in routine healthcare practice of 6 hospitals. The improvement in the patient's symptoms of anxiety and depression was analyzed as an indication for the effectiveness of the CMP. In order to assess the psychological distress, quality of life, and the functional status the German version of the Hospital Anxiety and Depression Scale (HADS) and a checklist of single-item-scales were administered at hospital admission (t1), 120 days later (t2) and one year after the hospital admission (t3). According to the HADS, the pre-post effect sizes of the psychooncological care program for 258 patients were 0.35 at t2 and 0.46 at t3. The effect sizes of 1.05 at t2 and 1.38 at t3 were calculated for the sub-group of patients with high psychological distress at t1. In 34.4 % of these patients clinical significant improvements in symptoms of anxiety and depression could be identified at t2 and in 45.3 % of the cases at t3. Symptom changes were significantly influenced by the patient's age and the intensity of psychooncological interventions. Symptom improvement was most evident for patients with a high use of psychooncological care. The correlation between HADS and single Item scales is in the moderate to high range. This is an indication of improvement not only in the psychological domain but also in the quality of life and functional status one year after the beginning of cancer treatment. These findings implicate that this study is one of the first to demonstrate the potential effectiveness of structured psychooncological care interventions in routine hospital care.
这项卫生服务研究的目的是调查癌症住院患者心理困扰的变化。根据结构化心理肿瘤护理项目“病例管理心理肿瘤学（CMP）”，患者在急性癌症治疗期间接受心理治疗。CMP在6家医院的常规医疗实践中实施。分析患者焦虑和抑郁症状的改善情况，以此作为CMP有效性的指标。为了评估心理困扰、生活质量和功能状态，在入院时（t1）、120天后（t2）和入院一年后（t3）使用了德语版医院焦虑抑郁量表（HADS）和单项量表清单。根据HADS，258名患者心理肿瘤护理项目在t2时的前后效应量为0.35，在t3时为0.46。对于t1时心理困扰程度高的患者亚组，t2时的效应量为1.05，t3时为1.38。在这些患者中，34.4%在t2时焦虑和抑郁症状有临床显著改善，45.3%在t3时有改善。症状变化受患者年龄和心理肿瘤干预强度的显著影响。心理肿瘤护理使用频繁的患者症状改善最为明显。HADS与单项量表之间的相关性处于中高范围。这表明不仅在心理领域有所改善，而且在癌症治疗开始一年后的生活质量和功能状态方面也有所改善。这些发现意味着本研究是首批证明结构化心理肿瘤护理干预在常规医院护理中具有潜在有效性的研究之一。
