Dockham Bonnie, Schafenacker Ann, Yoon Hyojin, Ronis David L, Kershaw Trace, Titler Marita, Northouse Laurel
Author Affiliations: Cancer Support Community of Greater Ann Arbor, Michigan (Ms Dockham); School of Nursing, University of Michigan, Ann Arbor (Ms Schafenacker and Drs Ronis, Titler, and Northouse); School of Nursing, Loyola University, Chicago, Illinois (Dr Yoon); and School of Public Health, Yale University, New Haven, Connecticut (Dr Kershaw).
Cancer Nurs. 2016 May-Jun;39(3):169-80. doi: 10.1097/NCC.0000000000000311.
Psychoeducational interventions, tested for efficacy in randomized clinical trials, are seldom implemented in clinical practice where cancer survivors and their family caregivers can benefit from them.
This study examined the effectiveness of the FOCUS Program on cancer survivors' and their family caregivers' outcomes when implemented at a Cancer Support Community (CSC) affiliate by agency social workers. Study aims were to (1) test effects of the program on survivor and caregiver outcomes as a unit and (2) determine program feasibility in terms of enrollment, retention, intervention fidelity, and satisfaction.
A preintervention and postintervention pilot effectiveness study was conducted with 34 cancer survivor-caregiver dyads (ie, pairs). The FOCUS Program, originally delivered by nurses in dyads' homes, was modified to a small-group format and delivered by CSC social workers. The primary outcome was quality of life (QOL). Intermediary outcomes were benefits of illness/caregiving, communication, support, and self-efficacy. Analyses included repeated-measures analysis of variance.
Dyads had significant improvements in total QOL; physical, emotional, and functional QOL; benefits of illness; and self-efficacy. Effect sizes were similar to prior randomized clinical trial findings. Although dyads were difficult to recruit (enrollment, 60%), both retention (92%) and intervention fidelity (94%) were high.
It was possible to implement the FOCUS Program at a CSC affiliate by agency staff, obtain positive intervention effects, and maintain intervention fidelity.
Researchers and clinicians need to collaborate to implement more evidence-based interventions in practice settings for cancer survivors and their family caregivers.
心理教育干预措施在随机临床试验中已得到疗效验证,但在临床实践中却很少实施,而癌症幸存者及其家庭护理人员本可从中受益。
本研究考察了“聚焦计划”在癌症支持社区(CSC)附属机构由机构社会工作者实施时,对癌症幸存者及其家庭护理人员的效果。研究目标包括:(1)将该计划作为一个整体,测试其对幸存者和护理人员的效果;(2)从招募、留存率、干预保真度和满意度方面确定该计划的可行性。
对34对癌症幸存者 - 护理人员进行了干预前和干预后的试点效果研究。“聚焦计划”最初由护士在护理人员家中以一对一的方式实施,现改为小组形式,由CSC社会工作者实施。主要结局指标是生活质量(QOL)。中间结局指标包括疾病/护理的益处、沟通、支持和自我效能感。分析方法包括重复测量方差分析。
这些配对在总体生活质量、身体、情感和功能生活质量、疾病益处和自我效能感方面有显著改善。效应量与之前随机临床试验的结果相似。尽管配对招募困难(招募率为60%),但留存率(92%)和干预保真度(94%)都很高。
机构工作人员有可能在CSC附属机构实施“聚焦计划”,获得积极的干预效果,并保持干预保真度。
研究人员和临床医生需要合作,在实际环境中为癌症幸存者及其家庭护理人员实施更多基于证据的干预措施。