Memorial Sloan Kettering Cancer Center, New York, NY, USA.
American Cancer Society, Atlanta, GA, USA.
Psychooncology. 2018 Mar;27(3):847-856. doi: 10.1002/pon.4583. Epub 2017 Dec 19.
Psychosocial interventions are historically underutilized by cancer caregivers, but support programs delivered flexibly over the Internet address multiple barriers to care. We adapted Meaning-Centered Psychotherapy for cancer caregivers, an in-person psychotherapeutic intervention intended to augment caregivers' sense of meaning and purpose and ameliorate burden, for delivery in a self-administered web-based program, the Care for the Cancer Caregiver (CCC) Workshop. The present study evaluated the feasibility, acceptability, and preliminary effects of this program.
Eighty-four caregivers were randomized to the CCC Workshop or waitlist control arm. Quantitative assessments of meaning, burden, anxiety, depression, benefit finding, and spiritual well-being were conducted preintervention (T1), within 2-weeks postintervention (T2), and 2- to 3-month follow-up (T3). In-depth semistructured interviews were conducted with a subset of participants.
Forty-two caregivers were randomized to the CCC Workshop. Attrition was moderate at T2 and T3, with caregiver burden and bereavement as key causes of drop-out. At T2 and T3, some observed mean change scores and effect sizes were consistent with hypothesized trends (eg, meaning in caregiving, benefit finding, and depressive symptomatology), though no pre-post significant differences emerged between groups. However, a longitudinal mixed-effects model found significant differential increases in benefit finding in favor of the CCC arm.
The CCC Workshop was feasible and acceptable. Based on effect sizes reported here, a larger study will likely establish the efficacy of the CCC Workshop, which has the potential to address unmet needs of caregivers who underutilize in-person supportive care services.
心理社会干预在癌症护理人员中历来未得到充分利用，但通过互联网灵活提供的支持计划可以解决多种护理障碍。我们对面向癌症护理人员的以意义为中心的心理疗法进行了改编，这是一种旨在增强护理人员意义感和目标感并减轻负担的人际心理治疗干预措施，以便在自我管理的基于网络的计划中实施，即癌症护理人员关爱（CCC）研讨会。本研究评估了该计划的可行性、可接受性和初步效果。
84 名护理人员随机分配至 CCC 研讨会或候补名单对照组。在干预前（T1）、干预后 2 周内（T2）和 2 至 3 个月随访（T3）进行意义、负担、焦虑、抑郁、受益发现和精神健康的定量评估。对一部分参与者进行了深入的半结构化访谈。
42 名护理人员被随机分配至 CCC 研讨会。T2 和 T3 的流失率较高，护理人员的负担和丧亲是退出的主要原因。在 T2 和 T3，一些观察到的平均变化分数和效果大小与假设的趋势一致（例如，照顾中的意义、受益发现和抑郁症状），尽管组间没有出现显著的前后差异。然而，纵向混合效应模型发现 CCC 组在受益发现方面有显著的差异增加。
CCC 研讨会是可行且可接受的。基于这里报告的效果大小，一项更大的研究可能会确定 CCC 研讨会的疗效，该研讨会有可能满足那些未充分利用人际支持服务的护理人员的未满足需求。
