正念训练对转移性癌症成人患者及其照顾者的生活质量和预先护理计划的支持作用：一项试点研究的结果
Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study.
作者信息
Johns Shelley A, Beck-Coon Kathleen, Stutz Patrick V, Talib Tasneem L, Chinh Kelly, Cottingham Ann H, Schmidt Karen, Shields Cleveland, Stout Madison E, Stump Timothy E, Monahan Patrick O, Torke Alexia M, Helft Paul R
机构信息
Indiana University School of Medicine, Indianapolis, IN, USA.
Regenstrief Institute, Inc, Indianapolis, IN, USA.
出版信息
Am J Hosp Palliat Care. 2020 Feb;37(2):88-99. doi: 10.1177/1049909119862254. Epub 2019 Aug 4.
BACKGROUND
Emotional distress often causes patients with cancer and their family caregivers (FCGs) to avoid end-of-life discussions and advance care planning (ACP), which may undermine quality of life (QoL). Most ACP interventions fail to address emotional barriers that impede timely ACP.
AIM
We assessed feasibility, acceptability, and preliminary effects of a mindfulness-based intervention to facilitate ACP for adults with advanced-stage cancer and their FCGs.
DESIGN
A single-arm pilot was conducted to assess the impact of a 6-week group mindfulness intervention on ACP behaviors (patients only), QoL, family communication, avoidant coping, distress, and other outcomes from baseline (T1) to post-intervention (T2) and 1 month later (T3).
PARTICIPANTS
Eligible patients had advanced-stage solid malignancies, limited ACP engagement, and an FCG willing to participate. Thirteen dyads (N = 26 participants) enrolled at an academic cancer center in the United States.
RESULTS
Of eligible patients, 59.1% enrolled. Attendance (70.8% across 6 sessions) and retention (84.6% for patients; 92.3% for FCGs) through T3 were acceptable. Over 90% of completers reported high intervention satisfaction. From T1 to T3, patient engagement more than doubled in each of 3 ACP behaviors assessed. Patients reported large significant decreases in distress at T2 and T3. Family caregivers reported large significant improvements in QoL and family communication at T2 and T3. Both patients and FCGs reported notable reductions in sleep disturbance and avoidant coping at T3.
CONCLUSIONS
The mindfulness intervention was feasible and acceptable and supported improvements in ACP and associated outcomes for patients and FCGs. A randomized trial of mindfulness training for ACP is warranted. The study is registered at ClinicalTrials.gov with identifier NCT02367508 ( https://clinicaltrials.gov/ct2/show/NCT02367508 ).
背景
情绪困扰常常导致癌症患者及其家庭照顾者（FCG）回避临终讨论和预先护理计划（ACP），这可能会损害生活质量（QoL）。大多数ACP干预措施未能解决阻碍及时进行ACP的情感障碍。
目的
我们评估了一种基于正念的干预措施对晚期癌症成人患者及其FCG促进ACP的可行性、可接受性和初步效果。
设计
进行了一项单臂试验，以评估为期6周的团体正念干预对从基线（T1）到干预后（T2）以及1个月后（T3）的ACP行为（仅针对患者）、生活质量、家庭沟通、回避应对、困扰及其他结果的影响。
参与者
符合条件的患者患有晚期实体恶性肿瘤，ACP参与度有限，且有愿意参与的FCG。在美国一家学术癌症中心招募了13对（N = 26名参与者）。
结果
符合条件的患者中，59.1%登记参加。到T3时的出勤率（6次课程的出勤率为70.8%）和留存率（患者为84.6%；FCG为92.3%）是可以接受的。超过90%的完成者报告对干预满意度高。从T1到T3，在评估的3种ACP行为中，每种行为的患者参与度都增加了一倍多。患者报告在T2和T3时困扰大幅显著降低。家庭照顾者报告在T2和T3时生活质量和家庭沟通有大幅显著改善。患者和FCG均报告在T3时睡眠障碍和回避应对显著减少。
结论
正念干预是可行且可接受的，并支持患者和FCG在ACP及相关结果方面的改善。有必要对ACP的正念训练进行随机试验。该研究已在ClinicalTrials.gov注册，标识符为NCT02367508（https://clinicaltrials.gov/ct2/show/NCT02367508）。
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