Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia; School of Behavioural Science, The University of Melbourne, Parkville, Australia; School of Nursing, The University of Melbourne, Parkville, Australia.
Psychooncology. 2013 Nov;22(11):2445-53. doi: 10.1002/pon.3306. Epub 2013 Jun 4.
People with inoperable lung cancer experience higher levels of distress, more unmet needs and symptoms than other cancer patients. There is an urgent need to test innovative approaches to improve psychosocial and symptom outcomes in this group. This study tested the hypothesis that a tailored, multidisciplinary supportive care programme based on systematic needs assessment would reduce perceived unmet needs and distress and improve quality of life.
A randomised controlled trial design was used. The tailored intervention comprised two sessions at treatment commencement and completion. Sessions included a self-completed needs assessment, active listening, self-care education and communication of unmet psychosocial and symptom needs to the multidisciplinary team for management and referral. Outcomes were assessed with the Needs Assessment for Advanced Lung Cancer Patients, Hospital Anxiety and Depression Scale, Distress Thermometer and European Organization of Research and Treatment of Cancer Quality of Life Q-C30 V2.0.
One hundred and eight patients with a diagnosis of inoperable lung or pleural cancer (including mesothelioma) were recruited from a specialist facility before the trial closed prematurely (original target 200). None of the primary contrasts of interest were significant (all p > 0.10), although change score analysis indicated a relative benefit from the intervention for unmet symptom needs at 8 and 12 weeks post-assessment (effect size = 0.55 and 0.40, respectively).
Although a novel approach, the hypothesis that the intervention would benefit perceived unmet needs, psychological morbidity, distress and health-related quality of life was not supported overall.
患有无法手术的肺癌的患者比其他癌症患者经历更高水平的痛苦、更多未满足的需求和症状。迫切需要测试创新方法来改善这一群体的心理社会和症状结局。本研究检验了一个假设，即基于系统需求评估的定制化多学科支持性护理方案将减少感知到的未满足需求和痛苦，并提高生活质量。
采用随机对照试验设计。定制干预包括治疗开始和结束时的两个阶段。阶段包括自我完成的需求评估、积极倾听、自我护理教育以及将未满足的心理社会和症状需求传达给多学科团队进行管理和转介。使用高级肺癌患者需求评估、医院焦虑和抑郁量表、痛苦温度计和欧洲癌症研究与治疗组织生活质量 Q-C30 V2.0 来评估结果。
在试验提前关闭（原目标 200 例）之前，从一家专门机构招募了 108 例患有不可手术的肺癌或胸膜癌（包括间皮瘤）的患者。所有主要的对比都没有显著意义（均 p > 0.10），尽管变化分数分析表明，在评估后 8 周和 12 周时，干预对未满足的症状需求有相对益处（效应大小分别为 0.55 和 0.40）。
尽管这是一种新颖的方法，但该假设即干预将有益于感知到的未满足需求、心理困扰、痛苦和健康相关的生活质量并没有得到全面支持。
