Massachusetts General Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Cancer. 2020 Apr 15;126(8):1758-1765. doi: 10.1002/cncr.32680. Epub 2020 Jan 3.
Caregivers of patients undergoing hematopoietic stem cell transplantation (HCT) experience an immense caregiving burden before, during, and after HCT.
We conducted an unblinded, randomized trial of a psychosocial intervention (BMT-CARE) for caregivers of patients undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomly assigned to BMT-CARE or usual care. BMT-CARE was tailored to the HCT trajectory and integrated treatment-related education and self-care with cognitive-behavioral skills to promote coping. Caregivers assigned to BMT-CARE met with a trained interventionist (a psychologist or a social worker) in person, via telephone, or via videoconferencing for 6 sessions starting before HCT and continuing up to day +60 after HCT. The primary endpoint was feasibility, which was defined as at least 60% of eligible caregivers enrolling and completing 50% or more of the intervention sessions. We assesed caregiver quality of life (QOL; Caregiver Oncology Quality of Life Questionnaire), caregiving burden (Caregiver Reaction Assessment), psychological distress (Hospital Anxiety and Depression Scale), self-efficacy (Cancer Self-Efficacy Scale-Transplant), and coping (Measures of Current Status) at baseline and 30 and 60 days after HCT. We used mixed linear effect models to assess the effect of BMT-CARE on outcomes longitudinally.
We enrolled 72.5% of eligible caregivers (100 of 138), and 80% attended 50% or more of the intervention sessions. Caregivers randomized to BMT-CARE reported improved QOL (B = 6.11; 95% CI, 3.50-8.71; P < .001), reduced caregiving burden (B = -6.02; 95% CI, -8.49 to -3.55; P < .001), lower anxiety (B = -2.18; 95% CI, -3.07 to -1.28; P < .001) and depression symptoms (B = -1.23; 95% CI, -1.92 to -0.54; P < .001), and improved self-efficacy (B = 7.22; 95% CI, 2.40-12.03; P = .003) and coping skills (B = 4.83; 95% CI, 3.04-6.94; P < .001) in comparison with the usual-care group.
A brief multimodal psychosocial intervention tailored for caregivers of HCT recipients is feasible and may improve QOL, mood, coping, and self-efficacy while reducing the caregiving burden during the acute HCT period.
造血干细胞移植（HCT）患者的护理人员在 HCT 之前、期间和之后都承受着巨大的护理负担。
我们对马萨诸塞州综合医院接受自体和同种异体 HCT 的患者的护理人员进行了一项未设盲、随机的心理社会干预（BMT-CARE）试验。护理人员被随机分配到 BMT-CARE 或常规护理。BMT-CARE 根据 HCT 轨迹进行定制，并将与治疗相关的教育和自我护理与认知行为技能相结合，以促进应对。被分配到 BMT-CARE 的护理人员与经过培训的干预者（心理学家或社会工作者）进行了 6 次面对面、电话或视频会议，从 HCT 前开始，一直持续到 HCT 后第 60 天。主要终点是可行性，定义为至少 60%的合格护理人员参与并完成 50%或更多的干预课程。我们在基线和 HCT 后 30 天和 60 天评估了护理人员的生活质量（护理人员肿瘤学生活质量问卷）、护理负担（护理人员反应评估）、心理困扰（医院焦虑和抑郁量表）、自我效能（癌症自我效能量表-移植）和应对能力（当前状态测量）。我们使用混合线性效应模型来纵向评估 BMT-CARE 对结果的影响。
我们招募了 72.5%的合格护理人员（138 名中的 100 名），80%的护理人员参加了 50%或更多的干预课程。与常规护理组相比，接受 BMT-CARE 的护理人员报告生活质量得到改善（B=6.11；95%CI，3.50-8.71；P<.001），护理负担减轻（B=-6.02；95%CI，-8.49 至-3.55；P<.001），焦虑（B=-2.18；95%CI，-3.07 至-1.28；P<.001）和抑郁症状（B=-1.23；95%CI，-1.92 至-0.54；P<.001）降低，自我效能（B=7.22；95%CI，2.40-12.03；P=.003）和应对技能（B=4.83；95%CI，3.04-6.94；P<.001）提高。
针对 HCT 受者护理人员的简短多模式心理社会干预是可行的，可能会改善生活质量、情绪、应对能力和自我效能感，同时减轻 HCT 期间的护理负担。
