Nahlén Bose Catarina, Persson Hans, Björling Gunilla, Ljunggren Gunnar, Elfström Magnus L, Saboonchi Fredrik
The Swedish Red Cross University College, Stockholm, Sweden
Department of Clinical Sciences Danderyd Hospital AB, Karolinska Institutet, Stockholm, Sweden.
Eur J Cardiovasc Nurs. 2016 Dec;15(7):537-548. doi: 10.1177/1474515115625033. Epub 2016 Jan 5.
Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).
To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.
Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).
No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).
CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.
情绪健康受损对慢性心力衰竭（CHF）患者的健康结局具有不利影响。
评估由护士主导的针对CHF患者的应对效能训练（CET）小组干预措施。研究假设CET会提高情绪健康水平（主要结局）和健康相关生活质量（HRQoL），并改善临床结局。此外，还研究了作为干预效果中介因素的评估和应对方式的变化。
参与者被随机分为接受标准医疗护理的对照组（n = 51）或CET干预组（n = 52）。在干预前、干预后以及六周、六个月和十二个月后，对积极情绪、消极情绪、抑郁、焦虑、HRQoL、疾病认知、应对策略和社会支持进行自我评估。在整个随访期间（中位时间35个月，四分位间距11个月）测量死亡时间和住院次数。
与对照组相比，干预组在情绪健康和HRQoL方面未发现显著改善。在排除基线时患有临床焦虑和抑郁的患者后，干预组的消极情绪显著更低（p = 0.022）。两组在心血管事件方面无显著差异。干预组在短期内对疾病的控制感更强（p = 0.036）。
发现CET干预在短期内可增强对疾病的控制感。目前，像CET这样针对CHF患者的心理社会支持项目在临床实践中缺乏实施依据。然而，这些结果为未来采用改良的CET干预设计和增加研究规模的研究提供了基础。
