Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, New South Wales, Australia.
J Med Imaging Radiat Sci. 2020 Mar;51(1):12-21. doi: 10.1016/j.jmir.2019.09.009. Epub 2019 Nov 20.
To ensure precision of treatment, patients requiring radiation therapy for treatment of head and neck cancer (HNC) are stabilized using a fitted thermoplastic immobilization mask. Despite evidence that many patients experience significant anxiety when restrained in the mask, there is a lack of proven interventions to prevent or manage mask-related anxiety. The Promoting Action on Research Implementation in Health Services implementation framework promotes consideration of context and culture when developing interventions to ensure successful implementation if proven effective. Health professionals (HPs) play a crucial role in the management of patients' psychological concerns, yet no studies have explored their perspectives of mask anxiety and how it should be managed. The aim of this study, therefore, was to elicit and analyse HPs' perspectives of mask anxiety, using the Promoting Action on Research Implementation in Health Services framework, to guide the development of implementation-ready interventions to reduce mask anxiety.
Semistructured interviews were conducted with 20 HPs involved in the care of HNC patients, including radiation oncologists, radiation therapists, nurses, and psychologists, from nine hospitals in NSW, Australia. Framework analysis methods were used.
Participants were on average 40 years old (range, 27-56), the majority were female (75%), and they had worked from 1 to 22 years with HNC patients. Six emergent themes were identified: (1) Mask anxiety is a significant problem but is easily missed; (2) Context matters; (3) Trust is critical; (4) Choice and control facilitate adjustment; (5) Psychological strategies are valued; and (6) Culture matters. Subgroup analysis also highlighted differences in perspectives between specialties.
Participants identified key principles underlying successful intervention. Two significant barriers to mask-anxiety intervention were identified: (1) a lack of empirical evidence surrounding its prevalence and predictors and (2) contextual and systematic hurdles making the health system potentially unresponsive to change. These data suggest a need for further descriptive studies and careful development of interventions which will address these hurdles.
为确保治疗的精确性，接受头颈部癌症（HNC）放射治疗的患者需要使用定制的热塑固定面罩进行固定。尽管有证据表明，许多患者在被面罩固定时会感到明显的焦虑，但目前缺乏预防或管理面罩相关焦虑的有效干预措施。促进卫生服务研究实施行动（Promoting Action on Research Implementation in Health Services，PARiHS）实施框架在制定干预措施时，提倡考虑背景和文化因素，以确保有效的干预措施在实施时能够取得成功。卫生专业人员（HPs）在管理患者的心理问题方面发挥着至关重要的作用，但目前尚无研究探讨他们对手套焦虑的看法以及应如何管理这种焦虑。因此，本研究旨在利用 Promoting Action on Research Implementation in Health Services 框架，深入分析和探讨 HPs 对手套焦虑的看法，以指导开发可有效减少焦虑的实施就绪型干预措施。
对来自澳大利亚新南威尔士州九家医院的 20 名参与头颈部癌症患者护理的 HPs（包括放射肿瘤学家、放射治疗师、护士和心理学家）进行了半结构化访谈。采用框架分析法。
参与者的平均年龄为 40 岁（范围为 27-56 岁），大多数为女性（75%），从事头颈部癌症患者护理工作的时间为 1-22 年。确定了六个主题：（1）面罩焦虑是一个严重的问题，但很容易被忽视；（2）背景很重要；（3）信任至关重要；（4）选择和控制有助于调整；（5）重视心理策略；（6）文化很重要。亚组分析还突出了不同专业之间观点的差异。
参与者确定了成功干预的关键原则。发现对手套焦虑干预的两个重大障碍：（1）缺乏关于其普遍性和预测因素的经验证据；（2）背景和系统障碍使医疗系统对变革反应迟钝。这些数据表明，需要进一步开展描述性研究，并谨慎制定干预措施，以解决这些障碍。
