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使用动机性访谈降低慢性疼痛和癌症患者在接受和承诺疗法、正念认知疗法和问题解决疗法中的脱落率。

Reducing dropout in acceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy for chronic pain and cancer patients using motivational interviewing.

机构信息

University of Nottingham, UK.

Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.

出版信息

Br J Clin Psychol. 2020 Sep;59(3):424-438. doi: 10.1111/bjc.12254. Epub 2020 Jun 1.


DOI:10.1111/bjc.12254
PMID:32478862
Abstract

OBJECTIVE: Acceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy are types of cognitive-behavioural therapy (CBT) group that improve physical and mental health in chronic pain or cancer. However, dropout is high due to group demands alongside physical impairments. Motivational interviewing (MI) is a well-evidenced means of enhancing treatment adherence. Few studies have investigated MI as an adjunct to CBT in cancer or chronic pain, and none have established the minimum MI duration required for adherence improvement. This study evaluated minimal-duration MI to improve adherence in three CBT group types for cancer and chronic pain. METHODS: In a cohort study of 99 cancer and chronic pain patients, 47 were given a 10- to 15-min structured MI telephone intervention (MI-call) after the first session. The remaining 52 received a CBT group without MI (no-MI). RESULTS: Odds of completing group CBTs were five times greater for patients in the MI-call cohort versus no-MI. Effects remained when controlling for age, gender, diagnosis, group type, and baseline quality of life. The MI-call cohort attended one extra session per patient compared to no-MI, controlling for age, gender, and diagnosis. CONCLUSIONS: A brief MI telephone intervention may improve adherence to group CBTs in cancer and chronic pain. PRACTITIONER POINTS: A brief motivational interviewing (MI) telephone intervention may reduce dropout from group cognitive-behavioural therapies (CBTs) for cancer and chronic pain patients when administered after the first group session in routine care. Recipients of this intervention were five times more likely to complete a group CBT programme than those who did not receive it. Therefore, a minimal-dose MI intervention can have clinically important effects on dropout in group CBTs for patients with long-term conditions. It is unclear whether this intervention would also result in greater outcome improvements.

摘要

目的:接受与承诺疗法、正念认知疗法和问题解决疗法是改善慢性疼痛或癌症患者身心健康的认知行为疗法(CBT)团体的类型。然而,由于团体需求和身体损伤,辍学率很高。动机访谈(MI)是增强治疗依从性的一种经过充分证实的方法。很少有研究将 MI 作为 CBT 在癌症或慢性疼痛中的辅助手段进行调查,也没有确定提高依从性所需的 MI 最短持续时间。本研究评估了 MI 的最短持续时间,以改善三种 CBT 团体类型在癌症和慢性疼痛中的依从性。

方法:在一项针对 99 名癌症和慢性疼痛患者的队列研究中,47 名患者在第一次会议后接受了 10-15 分钟的结构化 MI 电话干预(MI 电话)。其余 52 名患者接受了没有 MI 的 CBT 团体(无 MI)。

结果:与无 MI 相比,MI 电话组完成 CBT 团体的可能性是其五倍。在控制年龄、性别、诊断、团体类型和基线生活质量后,效果仍然存在。与无 MI 相比,MI 电话组每位患者多参加了一次治疗,这与年龄、性别和诊断有关。

结论:简短的 MI 电话干预可能会提高癌症和慢性疼痛患者对 CBT 团体治疗的依从性。

从业者要点:在常规护理中,在第一次团体会议后,对癌症和慢性疼痛患者进行简短的动机访谈(MI)电话干预,可能会减少团体认知行为疗法(CBT)的脱落率。接受该干预的患者完成团体 CBT 计划的可能性是未接受该干预的患者的五倍。因此,对于患有长期疾病的患者,最小剂量的 MI 干预对团体 CBT 的脱落率可能具有重要的临床意义。尚不清楚这种干预是否也会导致更大的结果改善。

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