Schofield Penelope, Chambers Suzanne
Department of Psychology, Swinburne University of Technology , Melbourne, Victoria , Australia.
Acta Oncol. 2015 May;54(5):805-12. doi: 10.3109/0284186X.2015.1010016. Epub 2015 Mar 27.
As the global burden of cancer increases healthcare services will face increasing challenges in meet the complex needs of these patients, their families and the communities in which they live. This raises the question of how to meet patient need where direct clinical contact may be constrained or not readily available. Patients and families require resources and skills to manage their illness outside of the hospital setting within their own communities.
To propose a framework for the development and delivery of psycho-educational and supportive care interventions drawing on theoretical principles of behaviour change and evidence-based interventions, and based on extensive experience in developing and testing complex interventions in oncology.
At the core of this intervention framework are considerations of efficiency: interventions are designed to cater for individuals' unique needs; to place minimal demands on the health system infrastructure and to be rapidly disseminated into usual care if successful. There are seven key features: 1) Targeting cancer type and stage; 2) Tailoring to unique individual needs; 3) Promotion of patient self-management of their disease and treatment side effects; 4) Efficient delivery of the intervention; 5) Training and adherence to protocol; 6) Ensuring the intervention is evidence-based; 7) Confirming stakeholder acceptability of the intervention.
A case study of a randomised controlled trial which tested psycho-educational oncology interventions using this framework is presented. These interventions were designed to cater for individuals' unique needs and promote self-management while placing minimal demands on the acute health care setting.
Innovative ways to realise the potentially major impact that psycho-educational and supportive care interventions can have on psychological morbidity, coping, symptoms and quality of life in serious and chronic illness are needed. This framework, which is driven by theory, evidence, and experience, is designed to ensure that interventions are effective, clinically feasible and sustainable.
随着全球癌症负担的增加，医疗保健服务在满足这些患者及其家庭以及他们所居住社区的复杂需求方面将面临越来越大的挑战。这就提出了一个问题，即在直接临床接触可能受到限制或难以实现的情况下，如何满足患者的需求。患者及其家庭需要资源和技能，以便在自己的社区内的医院环境之外管理他们的疾病。
借鉴行为改变的理论原则和循证干预措施，并基于在肿瘤学中开发和测试复杂干预措施的丰富经验，提出一个开发和提供心理教育及支持性护理干预措施的框架。
该干预框架的核心是对效率的考量：干预措施旨在满足个体的独特需求；对卫生系统基础设施的要求降至最低，并在成功后迅速推广到常规护理中。有七个关键特征：1）针对癌症类型和阶段；2）根据个体独特需求进行调整；3）促进患者对疾病及其治疗副作用的自我管理；4）高效实施干预措施；5）培训并遵守方案；6）确保干预措施基于证据；7）确认利益相关者对干预措施的可接受性。
介绍了一项随机对照试验的案例研究，该试验使用此框架测试了心理教育肿瘤学干预措施。这些干预措施旨在满足个体的独特需求并促进自我管理，同时对急性医疗保健环境的要求降至最低。
需要创新方法来实现心理教育和支持性护理干预措施对严重和慢性疾病的心理发病率、应对方式、症状和生活质量可能产生的重大影响。这个由理论、证据和经验驱动的框架旨在确保干预措施有效、临床可行且可持续。
