Danish Cancer Society Research Center,Copenhagen,Denmark.
Department of Psychology,University of Copenhagen,Copenhagen,Denmark.
Palliat Support Care. 2018 Apr;16(2):189-197. doi: 10.1017/S1478951517000141. Epub 2017 Mar 30.
ABSTRACTObjective:Patients with incurable cancer and their informal caregivers have numerous psychological and psychosocial needs. Many of these patients wish to receive their care and die at home. Few home-based specialized palliative care (SPC) interventions systematically integrate psychological support. We present a psychological intervention for patient-caregiver dyads developed for an ongoing randomized controlled trial (RCT) of home-based SPC, known as Domus, as well as the results of an assessment of its acceptability and feasibility.
The Domus model of SPC for patients with incurable cancer and their caregivers offered systematic psychological assessment and dyadic intervention as part of interdisciplinary care. Through accelerated transition to SPC, the aim of the model was to enhance patients' chances of receiving care and dying at home. Integration of psychological support sought to facilitate this goal by alleviating distress in patients and caregivers. Psychologists provided needs-based sessions based on existential-phenomenological therapy. Feasibility and acceptability were investigated by examining enrollment, nonparticipation, and completion of psychological sessions.
Enrollment in the RCT and uptake of the psychological intervention indicated that it was feasible and acceptable to patients and caregivers. The strengths of the intervention included its focus on dyads, psychological distress, and existential concerns, as well as interdisciplinary collaboration and psychological interventions offered according to need. Its main limitation was a lack of an intervention for other family members.
Our results show that psychological intervention can be systematically integrated into SPC and that it appears feasible to provide dyadic needs-based sessions with an existential therapeutic approach. The Domus RCT will provide evidence of the efficacy of a novel model of multidisciplinary SPC.
摘要
患有绝症的患者及其非正式照顾者有许多心理和社会心理需求。许多患者希望在家中接受护理和死亡。很少有基于家庭的专业姑息治疗（SPC）干预措施系统地整合心理支持。我们为正在进行的基于家庭的 SPC 随机对照试验（RCT）提出了一种针对患者-照顾者对的心理干预措施，称为 Domus，并评估了其可接受性和可行性。
Domus 模型为患有绝症的患者及其照顾者提供了系统的心理评估和对干预，作为多学科护理的一部分。通过加速过渡到 SPC，该模型的目的是增加患者在家中接受护理和死亡的机会。通过缓解患者和照顾者的痛苦，整合心理支持寻求实现这一目标。心理学家根据存在-现象学疗法提供基于需求的课程。通过检查登记、不参与和完成心理课程来调查可行性和可接受性。
RCT 的登记和心理干预的接受表明它对患者和照顾者是可行和可接受的。该干预措施的优势包括关注对、心理困扰和存在问题，以及跨学科合作和根据需求提供的心理干预。其主要限制是缺乏对其他家庭成员的干预措施。
我们的结果表明，心理干预可以系统地整合到 SPC 中，并且似乎可以提供基于对存在的需求的对课程。Domus RCT 将为多学科 SPC 的新型模型提供疗效证据。
