应对技巧实践与症状变化：肺癌患者及其家庭照护者试点电话症状管理干预的二次分析。

Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers.

机构信息

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.

Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.

出版信息

J Pain Symptom Manage. 2018 May;55(5):1341-1349.e4. doi: 10.1016/j.jpainsymman.2018.01.005. Epub 2018 Jan 31.

DOI:10.1016/j.jpainsymman.2018.01.005

PMID:29366911

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5899922/

Abstract

CONTEXT

Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers.

OBJECTIVES

To examine associations of coping skills practice to symptom change in a telephone symptom management (TSM) intervention delivered concurrently to lung cancer patients and their caregivers.

METHODS

This study was a secondary analysis of a randomized pilot trial. Data were examined from patient-caregiver dyads (n = 51 dyads) that were randomized to the TSM intervention. Guided by social cognitive theory, TSM involved four weekly sessions where dyads were taught coping skills including a mindfulness exercise, guided imagery, pursed lips breathing, cognitive restructuring, problem solving, emotion-focused coping, and assertive communication. Symptoms were assessed, including patients' and caregivers' psychological distress and patients' pain interference, fatigue interference, and distress related to breathlessness. Multiple regression analyses examined associations of coping skills practice during the intervention to symptoms at six weeks after the intervention.

RESULTS

For patients, greater practice of assertive communication was associated with less pain interference (β = -0.45, P = 0.02) and psychological distress (β = -0.36, P = 0.047); for caregivers, greater practice of guided imagery was associated with less psychological distress (β = -0.30, P = 0.01). Unexpectedly, for patients, greater practice of a mindfulness exercise was associated with higher pain (β = 0.47, P = 0.07) and fatigue interference (β = 0.49, P = 0.04); greater practice of problem solving was associated with higher distress related to breathlessness (β = 0.56, P = 0.01) and psychological distress (β = 0.36, P = 0.08).

CONCLUSION

Findings suggest that the effectiveness of TSM may have been reduced by competing effects of certain coping skills. Future interventions should consider focusing on assertive communication training for patients and guided imagery for caregivers.

摘要

背景

很少有研究探讨应对技巧练习与癌症患者及其家属照顾者的心理社会干预的症状结果之间的关系。

目的

在同时为肺癌患者及其照顾者提供的电话症状管理（TSM）干预中，检查应对技巧练习与症状变化的关联。

方法

这是一项随机试点试验的二次分析。从接受 TSM 干预的患者-照顾者对（n=51 对）中检查数据。TSM 以社会认知理论为指导，包括四个每周课程，向患者和照顾者教授应对技巧，包括正念练习、引导想象、唇齿紧闭呼吸、认知重构、解决问题、情绪聚焦应对和自信沟通。评估了症状，包括患者和照顾者的心理困扰以及患者的疼痛干扰、疲劳干扰和与呼吸困难相关的痛苦。多元回归分析检查了干预期间应对技巧练习与干预后六周时症状之间的关联。

结果

对于患者，自信沟通的练习量与疼痛干扰（β=-0.45，P=0.02）和心理困扰（β=-0.36，P=0.047）呈负相关；对于照顾者，指导想象的练习量与心理困扰（β=-0.30，P=0.01）呈负相关。出乎意料的是，对于患者，正念练习的练习量与更高的疼痛（β=0.47，P=0.07）和疲劳干扰（β=0.49，P=0.04）呈正相关；解决问题的练习量与呼吸困难相关的痛苦（β=0.56，P=0.01）和心理困扰（β=0.36，P=0.08）呈正相关。