Victoria M. White, Ashley Farrelly, and Michael Jefford, Cancer Council Victoria; Elizabeth Williamson and Ingrid Winship, The University of Melbourne; Ingrid Winship, Royal Melbourne Hospital; Elizabeth Williamson, Monash University, Melbourne; Mary-Anne Young and Michael Jefford, Peter MacCallum Cancer Centre, East Melbourne; Sandra Ieropoli, Early in Life Mental Health Service, Monash Health Mental Health Program, Clayton, Victoria; Bettina Meiser, Prince of Wales Clinical School, The University of New South Wales, Sydney; and Jessica Duffy, Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, New South Wales, Australia.
J Clin Oncol. 2014 Dec 20;32(36):4073-80. doi: 10.1200/JCO.2013.54.1607. Epub 2014 Nov 17.
To assess the effectiveness of a telephone-based peer-delivered intervention in reducing distress among women with a BRCA1 or BRCA2 gene mutation. The intervention involved trained peer volunteers contacting women multiple times over a 4-month period to provide informational, emotional, and practical support.
Three hundred thirty-seven participants completed the baseline questionnaire, and those reporting interest in talking to other mutation carriers were randomly assigned to either the usual care group (UCG; n = 102) or the intervention group (IG; n = 105). Participants and researchers were not blinded to group allocation. Two follow-up questionnaires were completed, one at the end of the intervention (4 months after random assignment, time 2) and one 2 months later (time 3). Outcomes included breast cancer distress (primary outcome), unmet information needs, cognitive appraisals about mutation testing, and feelings of isolation.
There was a greater decrease in breast cancer distress scores in the IG than UCG at time 2 (mean difference, -5.96; 95% CI, -9.80 to -2.12; P = .002) and time 3 (mean difference, -3.94; 95% CI, -7.70 to -0.17; P = .04). There was a greater reduction in unmet information needs in the IG than UCG (P < .01), with unmet needs being lower in the IG than UCG at time 2. There was a greater reduction in Cognitive Appraisals About Genetic Testing stress subscale scores in the IG than UCG (P = .02), with significantly lower scores among the IG than UCG at time 2 (P < .01).
The intervention is effective in reducing distress and unmet information needs for this group of women. Identifying strategies for prolonging intervention effects is warranted.
评估基于电话的同伴提供的干预措施在减少携带 BRCA1 或 BRCA2 基因突变的女性的痛苦方面的有效性。该干预措施包括培训过的同伴志愿者在 4 个月的时间内多次与女性联系,提供信息、情感和实际支持。
337 名参与者完成了基线问卷,那些表示有兴趣与其他突变携带者交谈的人被随机分配到常规护理组(UCG;n=102)或干预组(IG;n=105)。参与者和研究人员对分组分配不知情。完成了两份随访问卷,一份在干预结束时(随机分组后 4 个月,时间 2),一份在 2 个月后(时间 3)。结果包括乳腺癌困扰(主要结果)、未满足的信息需求、对突变检测的认知评估以及孤立感。
IG 的乳腺癌困扰评分在时间 2(平均差异,-5.96;95%CI,-9.80 至-2.12;P=.002)和时间 3(平均差异,-3.94;95%CI,-7.70 至-0.17;P=.04)时下降幅度大于 UCG。IG 的未满足信息需求比 UCG 减少更多(P<.01),IG 的未满足需求在时间 2 时低于 UCG。IG 的认知评估关于基因检测应激分量表评分比 UCG 降低更多(P=.02),IG 的评分明显低于 UCG(P<.01)。
该干预措施对减轻这组女性的痛苦和未满足的信息需求有效。确定延长干预效果的策略是合理的。