Smith Sophia K, O'Donnell Jonathan D, Abernethy Amy P, MacDermott Kristin, Staley Tina, Samsa Gregory P
Duke University School of Nursing, Durham, NC, USA.
Duke Clinical Research Institute, Durham, NC, USA.
Psychooncology. 2015 Nov;24(11):1407-15. doi: 10.1002/pon.3750. Epub 2015 Jan 28.
Pillars4Life is an educational program that teaches coping skills to cancer patients in a virtual group setting; it was recently implemented at 17 hospitals across the USA. The cost-effective, scalable, and assessable Pillars4Life curriculum targets psychosocial resources (e.g., self-efficacy and coping skills) as a means to reduce symptoms (e.g., depression, anxiety, and posttraumatic stress) and enhance quality of life.
Cancer patients were recruited from hospitals that received the LIVESTRONG Community Impact Project Award to enroll in a pilot study of Pillars4Life. Consenting participants met with a certified instructor weekly for 10 weeks in a virtual environment; the manualized intervention trained participants in personal coping skills. Longitudinal assessments over 6 months were assessed using validated instruments to determine changes in Pillars4Life targeted resources and outcomes. Multiple linear regression models examined the relationship between changes in targeted resources and changes in outcome from baseline to 3 months post-intervention.
Participants (n = 130) had the following characteristics: mean age of 56 ± 11 years, 87% women, 11% non-Caucasian, and 77% with college degree. At 3- and 6-month follow-up, mean scores improved on all key outcome measures such as depression (Patient Health Questionnaire), anxiety (Generalized Anxiety Disorder), posttraumatic stress (Posttraumatic Stress Disorder Checklist), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and well-being (Functional Assessment of Cancer Therapy-General) from baseline (all p < 0.01); results were most pronounced among participants who reported ≥4/10 on the Distress Thermometer at baseline (all p < 0.001). Changes in each targeted resource were associated with 3-month improvements in at least one outcome.
Participation in the Pillars4Life program was associated with statistically and clinically significant improvements in scores on pre-specified outcomes and targeted resources.
“支柱4生命”是一个教育项目，在虚拟小组环境中向癌症患者传授应对技巧；该项目最近在美国的17家医院实施。具有成本效益、可扩展且可评估的“支柱4生命”课程以心理社会资源（如自我效能感和应对技巧）为目标，作为减轻症状（如抑郁、焦虑和创伤后应激）并提高生活质量的一种手段。
从获得“坚强生活社区影响项目奖”的医院招募癌症患者，参加“支柱4生命”的一项试点研究。同意参与的参与者在虚拟环境中每周与一名认证教员会面，为期10周；该标准化干预培训参与者的个人应对技巧。使用经过验证的工具进行为期6个月的纵向评估，以确定“支柱4生命”目标资源和结果的变化。多元线性回归模型检验了目标资源变化与干预后3个月相对于基线的结果变化之间的关系。
参与者（n = 130）具有以下特征：平均年龄56±11岁，87%为女性，11%为非白种人，77%拥有大学学位。在3个月和6个月的随访中，所有关键结果指标的平均得分均较基线有所改善，如抑郁（患者健康问卷）、焦虑（广泛性焦虑症）、创伤后应激（创伤后应激障碍检查表）、疲劳（慢性病治疗功能评估-疲劳）和幸福感（癌症治疗功能评估-一般）（所有p < 0.01）；在基线时在痛苦温度计上报告≥4/10的参与者中，结果最为显著（所有p < 0.001）。每种目标资源的变化与至少一项结果在3个月时的改善相关。
参与“支柱4生命”项目与预先指定的结果和目标资源得分在统计学和临床上的显著改善相关。
