Donovan Heidi S, Kwekkeboom Kristine L, Rosenzweig Margaret Q, Ward Sandra E
University of Pittsburgh School of Nursing, USA.
West J Nurs Res. 2009 Dec;31(8):983-98. doi: 10.1177/0193945909338488.
Randomized clinical trials support the efficacy of a wide range of psychoeducational interventions. However, the mechanisms through which these interventions improve outcomes are not always clear. At times, the theoretically specified factors within interventions have been shown to have specific effects on patient outcomes. But it has also been argued that other factors not identified in the intervention theory (e.g., "nonspecific" factors such as patient expectations and therapeutic patient-clinician alliances) have powerful nonspecific effects that account for most, if not all, of the observed efficacy of psychoeducational interventions. This article describes important concepts in this debate and discusses key issues in distinguishing between specific and nonspecific effects of psychoeducational nursing interventions. Four examples are used to illustrate potential methods of identifying and controlling for nonspecific effects in clinical intervention trials.
随机临床试验证明了多种心理教育干预措施的有效性。然而，这些干预措施改善治疗效果的机制并不总是清晰的。有时，干预措施中理论上明确的因素已被证明对患者的治疗效果有特定影响。但也有人认为，干预理论中未明确的其他因素（例如患者期望和治疗性医患联盟等“非特异性”因素）具有强大的非特异性影响，即使不能解释所有观察到的心理教育干预效果，也能解释大部分。本文描述了这场辩论中的重要概念，并讨论了区分心理教育护理干预的特异性和非特异性效果的关键问题。文中使用了四个例子来说明在临床干预试验中识别和控制非特异性效果的潜在方法。
