Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Mental Health and Behavioral Sciences Service, Miami Veterans Affairs Healthcare System, Miami, FL, USA.
Transl Behav Med. 2019 Jul 16;9(4):629-637. doi: 10.1093/tbm/iby089.
Relative to non-Hispanic whites (NHW), black men are disproportionately affected by prostate cancer (PC) incidence, have poorer PC outcomes, and report greater compromises in health-related quality of life. Despite these challenges, black men are underrepresented in psychosocial cancer research, possibly due to limited access to supportive oncology programs. The purpose of this article is to examine the acceptability and efficacy for reducing disease-specific distress of a tablet-delivered psychosocial intervention for older men with advanced PC (APC) and explore differences by race. Men with APC (N = 192, 37.5% black, age M = 68.84 years) were randomized to 10-week Cognitive Behavioral Stress Management (CBSM) or attention-control Health Promotion (HP), both delivered via tablets. Assessments occurred at baseline in person, weekly during the 10-week program via tablets, and at 6 and 12 months in person. Weekly session evaluations and postprogram exit surveys assessed acceptability. Efficacy was assessed with a measure of PC-anxiety validated with racially diverse PC patients using linear mixed effects modeling. Study retention and group attendance did not differ by race. CBSM and HP were both acceptable among older APC patients. Black men rated both conditions more favorably than NHW men. Men in CBSM (vs. HP) reported greater reductions in PC-anxiety at 6 months (not sustained at 12 months). Black men in CBSM reported greater decreases in PC-anxiety over time compared with all other groups. Tablet-delivered CBSM and HP were acceptable for black and NHW APC patients, although black men rated both conditions more favorably. Black men reported a unique intervention benefit related to reduced disease-specific distress.
与非西班牙裔白人（NHW）相比，黑人男性患前列腺癌（PC）的比例不成比例，PC 预后较差，并且报告在与健康相关的生活质量方面受到更大的影响。尽管存在这些挑战，但在心理社会癌症研究中，黑人男性的代表性不足，这可能是由于获得支持性肿瘤学计划的机会有限。本文的目的是检查一种针对晚期 PC（APC）老年男性的平板电脑心理社会干预措施的可接受性和减轻疾病特异性困扰的效果，并探讨种族差异。将 192 名 APC 男性（37.5%为黑人，年龄 M = 68.84 岁）随机分为 10 周认知行为应激管理（CBSM）或平板电脑提供的注意力控制健康促进（HP）组。在基线时进行了面对面评估，在 10 周的方案期间每周通过平板电脑进行评估，在 6 个月和 12 个月时进行面对面评估。每周的会议评估和方案后退出调查评估了可接受性。使用针对不同种族的 PC 患者进行验证的 PC 焦虑措施评估了功效，采用线性混合效应模型。种族之间的研究保留率和小组出勤率没有差异。CBSM 和 HP 在老年 APC 患者中均具有可接受性。黑人男性对这两种情况的评价均优于 NHW 男性。与 HP 相比，CBSM 中的男性在 6 个月时（12 个月时未持续）报告 PC 焦虑降低幅度更大。与其他所有组相比，CBSM 中的黑人男性在随时间推移时 PC 焦虑的降低幅度更大。平板电脑提供的 CBSM 和 HP 对黑人男性和 NHW APC 患者均具有可接受性，尽管黑人男性对这两种情况的评价更为有利。黑人男性报告了与降低疾病特异性困扰有关的独特干预效果。
