Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society Faculty of Medicine, University of Liverpool Brownlow Hill, Liverpool L69 3GB, United Kingdom.
J Affect Disord. 2013 May 15;148(1):141-5. doi: 10.1016/j.jad.2012.11.013. Epub 2012 Dec 7.
A pilot trial was carried out to determine if a focussed narrative interview could alleviate the components of suffering and anxiety and depression in advanced cancer patients.
Patients recruited were invited to participate in a focussed narrative interview and reflect on their perspectives on their sense of "meaning", regarding suffering and their psychological, physical, social and spiritual well being - the emphasis was on allowing the patient to tell their story. Patients were encouraged to share what resources they themselves had utilised in addition to what professional care they may have received, to maintain a sense of well being.
Patients with advanced metastatic disease were recruited from hospices in the North West of England - the only exclusion criteria were not being able to understand written and spoken English and a non cancer diagnosis. At recruitment patients were asked to complete a numerical scale for suffering; the Brief Edinburgh Depression Scale, Edmonton Symptom Assessment Scale (ESAS), FACIT Spiritual well being questionnaire, Demographic information was collected and patients were randomised to either the intervention arm of the trial or the usual care arm of the study. Patients in both groups were invited to complete each measure at 2, 4 and 8 weeks.
One hundred people were recruited into the study - 49 were randomised to intervention group and 51 to control group. The median age of patients was 66 years age range (31-89 years) and 68% of patients were female. At baseline the ECOG performance of 75% of patients recruited was 1 or 2. The median survival of all patients in the study was 169.5 days (range 10 days to still alive at end of study). There was no significant difference at any timepoint in scores on suffering measure between intervention group and control group. At each time point the intervention demonstrated mean improvement in scores for depression and anxiety on ESAS - the greatest changes for both depression and anxiety were seen at 4 weeks.
This pilot randomised controlled trial of a focussed narrative intervention demonstrated an improvement in mean changes in scores for depression and anxiety at 2, 4, and 8 weeks. We suggest this intervention may have beneficial effects on depression and anxiety, but a larger powered trial is required to determine the full effects.
进行了一项试点试验，以确定集中叙事访谈是否可以减轻晚期癌症患者的痛苦、焦虑和抑郁症状。
招募的患者受邀参加集中叙事访谈，并反思他们对痛苦的“意义”的看法，以及他们的心理、身体、社会和精神健康状况——重点是让患者讲述自己的故事。鼓励患者分享他们自己利用的资源，以及他们可能接受的专业护理，以保持幸福感。
从英格兰西北部的临终关怀机构招募患有晚期转移性疾病的患者——唯一的排除标准是无法理解书面和口头英语以及非癌症诊断。在招募时，患者被要求完成痛苦的数字量表；简要爱丁堡抑郁量表、埃德蒙顿症状评估量表（ESAS）、FACIT 精神幸福感问卷、收集人口统计学信息，并将患者随机分配到试验的干预组或研究的常规护理组。两组患者均被邀请在 2、4 和 8 周时完成每项测量。
该研究共招募了 100 人——49 人被随机分配到干预组，51 人被分配到对照组。患者的中位年龄为 66 岁（年龄范围为 31-89 岁），68%的患者为女性。在基线时，招募的患者中有 75%的 ECOG 表现为 1 或 2。研究中所有患者的中位生存期为 169.5 天（范围为 10 天至研究结束时仍存活）。在任何时间点，干预组和对照组的痛苦量表评分均无显著差异。在每个时间点，ESAS 上的抑郁和焦虑评分都显示出干预的平均改善——抑郁和焦虑的最大变化发生在 4 周时。
这项集中叙事干预的随机对照试验试点表明，在 2、4 和 8 周时，抑郁和焦虑评分的平均变化有所改善。我们认为这种干预可能对抑郁和焦虑有有益的影响，但需要更大规模的、有力的试验来确定其全部效果。
