von Heymann-Horan Annika, Bidstrup Pernille Envold, Johansen Christoffer, Rottmann Nina, Andersen Elisabeth Anne Wreford, Sjøgren Per, von der Maase Hans, Timm Helle, Kjellberg Jakob, Guldin Mai-Britt
Danish Cancer Society Research Center, Copenhagen, Denmark.
Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Psychooncology. 2019 Feb;28(2):264-270. doi: 10.1002/pon.4932. Epub 2018 Nov 15.
Specialized palliative care (SPC) interventions increasingly include patient-caregiver dyads, but their effects on dyadic coping are unknown. We investigated whether an SPC and dyadic psychological intervention increased aspects of dyadic coping in patients with advanced cancer and their caregivers, whether dyad characteristics moderated effects and whether aspects of dyadic coping mediated significant intervention effects on caregivers' anxiety and depression.
We randomized 258 patients with incurable cancer and their caregivers to care as usual or accelerated transition from oncological treatment to home-based SPC and dyadic psychological support. In secondary outcome analyses, using mixed-effects models, we estimated intervention effects and 95% confidence intervals (CIs) for communication of stress and common coping, and moderation by dyad type and demographics. In path analyses, we investigated whether stress communication and common coping mediated intervention effects on caregivers' symptoms of anxiety and depression. (Clinicaltrials.gov NCT01885637).
The intervention significantly increased common coping in patients and caregivers in couples (estimated difference, 0.68; 95% CI, 0.11 to 1.24) and stress communication by partner caregivers (0.97; 0.24 to 1.24). We found some support for different intervention effects for spouses and other dyads, but no evidence of mediation.
Specialized palliative care and dyadic psychological intervention may affect aspects of dyadic coping. Common coping and stress communication did not mediate the previously found significant intervention effects on caregiver anxiety and depression, indicating that other mechanisms may have been central in the intervention.
专业姑息治疗（SPC）干预措施越来越多地纳入患者-照护者二元组，但这些干预措施对二元应对的影响尚不清楚。我们调查了SPC和二元心理干预是否增加了晚期癌症患者及其照护者的二元应对方面，二元组特征是否调节了干预效果，以及二元应对方面是否介导了对照护者焦虑和抑郁的显著干预效果。
我们将258例无法治愈的癌症患者及其照护者随机分为常规护理组或从肿瘤治疗加速过渡到居家SPC和二元心理支持组。在次要结局分析中，我们使用混合效应模型估计干预效果以及压力沟通和共同应对的95%置信区间（CI），并分析二元组类型和人口统计学特征的调节作用。在路径分析中，我们研究了压力沟通和共同应对是否介导了干预对照护者焦虑和抑郁症状的影响。（Clinicaltrials.gov标识符：NCT01885637）。
干预显著增加了夫妻组患者和照护者的共同应对（估计差异为0.68；95%CI为0.11至1.24）以及伴侣照护者的压力沟通（0.97；0.24至1.24）。我们发现配偶和其他二元组的干预效果存在一些差异，但没有中介作用的证据。
专业姑息治疗和二元心理干预可能会影响二元应对的某些方面。共同应对和压力沟通并未介导先前发现的对照护者焦虑和抑郁的显著干预效果，这表明其他机制可能在干预中起核心作用。
