Department of Nursing and Supportive Care Research, Peter MacCallum Cancer Centre, Melbourne; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne.
Department of Nursing and Supportive Care Research, Peter MacCallum Cancer Centre, Melbourne; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne; Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne.
Ann Oncol. 2012 Jan;23(1):222-231. doi: 10.1093/annonc/mdr042. Epub 2011 Apr 6.
High levels of distress and need for self-care information by patients commencing chemotherapy suggest that current prechemotherapy education is suboptimal. We conducted a randomised, controlled trial of a prechemotherapy education intervention (ChemoEd) to assess impact on patient distress, treatment-related concerns, and the prevalence and severity of and bother caused by six chemotherapy side-effects.
One hundred and ninety-two breast, gastrointestinal, and haematologic cancer patients were recruited before the trial closing prematurely (original target 352). ChemoEd patients received a DVD, question-prompt list, self-care information, an education consultation≥24 h before first treatment (intervention 1), telephone follow-up 48 h after first treatment (intervention 2), and a face-to-face review immediately before second treatment (intervention 3). Patient outcomes were measured at baseline (T1: pre-education) and immediately preceding treatment cycles 1 (T2) and 3 (T3).
ChemoEd did not significantly reduce patient distress. However, a significant decrease in sensory/psychological (P=0.027) and procedural (P=0.03) concerns, as well as prevalence and severity of and bother due to vomiting (all P=0.001), were observed at T3. In addition, subgroup analysis of patients with elevated distress at T1 indicated a significant decrease (P=0.035) at T2 but not at T3 (P=0.055) in ChemoEd patients.
ChemoEd holds promise to improve patient treatment-related concerns and some physical/psychological outcomes; however, further research is required on more diverse patient populations to ensure generalisability.
接受化疗的患者表现出高度的痛苦和对自我护理信息的需求，这表明当前的化疗前教育并不理想。我们进行了一项化疗前教育干预（ChemoEd）的随机对照试验，以评估其对患者痛苦、与治疗相关的担忧、以及六种化疗副作用的发生率、严重程度和困扰程度的影响。
在试验提前结束（原目标 352 例）之前，招募了 192 例乳腺癌、胃肠道癌和血液癌患者。ChemoEd 组患者在首次治疗前 24 小时以上（干预 1）接受 DVD、问题提示清单、自我护理信息、教育咨询、首次治疗后 48 小时（干预 2）电话随访和第二次治疗前立即进行面对面复查（干预 3）。在基线（T1：教育前）和首次治疗周期 1（T2）和 3（T3）前测量患者结局。
ChemoEd 并未显著降低患者的痛苦。然而，在 T3 时观察到，在感觉/心理（P=0.027）和程序（P=0.03）担忧、呕吐的发生率、严重程度和困扰程度方面均显著降低（均 P=0.001）。此外，对 T1 时痛苦水平升高的患者进行亚组分析显示，ChemoEd 组在 T2 时显著降低（P=0.035），但在 T3 时没有降低（P=0.055）。
ChemoEd 有希望改善患者与治疗相关的担忧和某些身体/心理结果；然而，需要对更多样化的患者群体进行进一步研究，以确保其可推广性。
