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一项基于集成式医疗服务提供系统的针对癌症患者和非专业癌症护理人员的移动医疗正念干预的随机对照试验:一项可行性研究。

A Randomized Controlled Trial of mHealth Mindfulness Intervention for Cancer Patients and Informal Cancer Caregivers: A Feasibility Study Within an Integrated Health Care Delivery System.

机构信息

1 Kaiser Permanente Division of Research, Oakland, CA, USA.

2 Kaiser Permanente Napa/Solano Medical Center, Vallejo, CA, USA.

出版信息

Integr Cancer Ther. 2019 Jan-Dec;18:1534735419850634. doi: 10.1177/1534735419850634.

Abstract

PURPOSE

To assess feasibility and preliminary efficacy of a mobile/online-based (mHealth) mindfulness intervention for cancer patients and their caregivers to reduce distress and improve quality of life (QoL).

MATERIAL AND METHODS

Two-arm randomized controlled trial within Kaiser Permanente Northern California targeting cancer patients who received chemotherapy and their informal caregivers. The intervention group received a commercially available mindfulness program for 8 weeks. The wait-list control group received usual care. We assessed feasibility using retention and adherence rates and obtained participant-reported data on distress, QoL, sleep, mindfulness, and posttraumatic growth before and immediately after the intervention.

RESULTS

Ninety-seven patients (median age 59 years; female 69%; 65% whites) and 31 caregivers (median age 63 years; female 58%; 77% whites) were randomized. Among randomized participants, 74% of the patients and 84% of the caregivers completed the study. Among those in the intervention arm who initiated the mindfulness program, 65% practiced at least 50% of the days during the intervention period. We observed significantly greater improvement in QoL among patients in the intervention arm compared with controls. Caregivers in the intervention group experienced increased mindfulness compared with controls. Participants appreciated the convenience of the intervention and the mindfulness skills they obtained from the program.

CONCLUSION

We demonstrated the feasibility of conducting a randomized trial of an mHealth mindfulness intervention for cancer patients and their informal caregivers. Results from fully powered efficacy trials would inform the potential for clinicians to use this scalable intervention to help improve QoL of those affected by cancer and their caregivers.

摘要

目的

评估基于移动/在线(移动医疗)的正念干预措施在癌症患者及其照护者中的可行性和初步疗效,以减轻痛苦并改善生活质量(QoL)。

材料和方法

这是一项在 Kaiser Permanente Northern California 内进行的、针对接受化疗的癌症患者及其非正式照护者的两臂随机对照试验。干预组接受为期 8 周的商业正念课程。等候名单对照组接受常规护理。我们通过保留率和依从率评估可行性,并在干预前后获得参与者报告的关于痛苦、生活质量、睡眠、正念和创伤后成长的数据。

结果

共有 97 名患者(中位年龄 59 岁;女性 69%;65%为白人)和 31 名照护者(中位年龄 63 岁;女性 58%;77%为白人)被随机分组。在随机分组的参与者中,74%的患者和 84%的照护者完成了研究。在干预组中开始正念课程的参与者中,有 65%在干预期间至少有 50%的天数进行了练习。与对照组相比,干预组患者的生活质量显著改善。与对照组相比,干预组的照护者正念水平提高。参与者赞赏干预的便利性和他们从该计划中获得的正念技能。

结论

我们证明了对癌症患者及其非正式照护者进行移动医疗正念干预的随机试验的可行性。充分有力的疗效试验结果将为临床医生使用这种可扩展的干预措施来帮助改善癌症患者及其照护者的生活质量提供依据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ecc4/6537293/ec0a7fa97676/10.1177_1534735419850634-fig1.jpg

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