Milbury Kathrin, Lopez Gabriel, Spelman Amy, Wood Christopher, Matin Surena F, Tannir Nizar M, Jonasch Eric, Pisters Louis, Wei Qi, Cohen Lorenzo
Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Psychooncology. 2017 Sep;26(9):1361-1368. doi: 10.1002/pon.4148. Epub 2016 May 3.
To identify groups most likely to benefit from an Expressive Writing (EW) intervention, we examined psychosocial variables as intervention moderators. We hypothesized that EW would be particularly effective for participants with high levels of depressive symptoms and social support at study entry.
Patients (n = 277; 60.6% male) with kidney cancer were randomly assigned to either an expressive (EW) or neutral writing (NW) condition. Intervention outcomes included measures of depressive symptoms (CESD), cancer-related symptoms (MDASI), fatigue (BFI), and sleep disturbances (PSQI) assessed at baseline, 1, 4, and 10 months later. Moderators were measured at baseline.
As hypothesized, depressive symptoms and social support moderated intervention efficacy. When examining both moderators simultaneously, EW appeared to be most effective in terms of cancer-related symptoms (p < 0.05) and depressive symptoms (p < 0.01) for participants with elevated depressive symptoms who received high levels of social support at baseline relative to their counterparts in the NW condition. Moreover, participants in EW with high levels of social support at baseline reported lower levels sleep disturbances (p = 0.005) than their counterparts in NW.
Recognition of baseline depressive symptoms and social support as intervention moderators may lead to improved patient selection for EW interventions, as EW may be particularly beneficial regarding QOL outcomes for patients that have social support available including participants with depressive symptoms. EW may not be beneficial, or potentially even contraindicated, for participants lacking social support. Copyright © 2016 John Wiley & Sons, Ltd.
为了确定最有可能从表达性写作（EW）干预中获益的群体，我们将心理社会变量作为干预调节因素进行了研究。我们假设，对于研究开始时抑郁症状水平高且社会支持水平高的参与者，EW将特别有效。
将277例肾癌患者（男性占60.6%）随机分为表达性写作（EW）组或中性写作（NW）组。干预结果包括在基线、1个月、4个月和10个月后评估的抑郁症状（CESD）、癌症相关症状（MDASI）、疲劳（BFI）和睡眠障碍（PSQI）的测量指标。调节因素在基线时进行测量。
正如所假设的，抑郁症状和社会支持调节了干预效果。当同时考察这两个调节因素时，对于那些在基线时抑郁症状较高且相对于NW组的对应参与者获得高水平社会支持的参与者，EW在癌症相关症状（p<0.05）和抑郁症状（p<0.01）方面似乎最有效。此外，基线时社会支持水平高的EW组参与者报告的睡眠障碍水平（p = 0.005）低于NW组的对应参与者。
将基线抑郁症状和社会支持作为干预调节因素加以识别，可能会改善EW干预的患者选择，因为EW对于那些有社会支持的患者（包括有抑郁症状的参与者）的生活质量结局可能特别有益。对于缺乏社会支持的参与者，EW可能无益，甚至可能有禁忌。版权所有© 2016约翰·威利父子有限公司。
