Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore; Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore.
Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore.
J Pain Symptom Manage. 2020 Dec;60(6):1200-1207. doi: 10.1016/j.jpainsymman.2020.06.016. Epub 2020 Jun 20.
Advanced colorectal cancer and its treatment can bring about challenges associated with psychological distress.
The primary aims of this study were to examine the feasibility and acceptability of a cognitive behavioral therapy (CBT)-based intervention to improve coping with the disease. The secondary aim is to evaluate preliminary intervention efficacy.
Patients with advanced colorectal cancer in Singapore (N = 60) were randomized to either receive a four-session CBT intervention immediately or be waitlisted. Intervention feasibility (i.e., recruitment and intervention adherence) and acceptability (i.e., participant satisfaction and cultural sensitivity) were assessed. Changes in psychological distress and self-efficacy were examined.
The study successfully recruited the intended sample (mean age 61; 62% men). A proportion (12%) reported Hospital Anxiety and Depression Scale scores indicative of distress at baseline. Most (88%) completed all sessions. Participants reported high rates of satisfaction (97%), helpfulness (96%), and cultural sensitivity (95%) of the intervention. The intervention group did not show decrease in psychological distress; however, self-efficacy in cancer-related coping (information seeking: effect size [ES] = 0.64; 95% CI = 0.17, 0.85; coping with side effects: ES = 0.69; 95% CI = 0.33, 0.82; and maintaining positive attitude: ES = 0.45; 95% CI = 0.19, 0.79) increased in the intervention group compared with the waitlisted group.
The CBT-based intervention was feasible and acceptable to patients in Singapore. There is no sufficient evidence to warrant a larger trial in this sample with low baseline distress. Future work should identify and target those who are most in need of support.
晚期结直肠癌及其治疗可能会带来与心理困扰相关的挑战。
本研究的主要目的是检验一种基于认知行为疗法（CBT）的干预措施改善疾病应对能力的可行性和可接受性。次要目的是评估初步的干预效果。
新加坡的 60 名晚期结直肠癌患者被随机分为立即接受四节 CBT 干预组或候补组。评估干预的可行性（即招募和干预依从性）和可接受性（即参与者满意度和文化敏感性）。还检查了心理困扰和自我效能感的变化。
该研究成功招募了预期的样本（平均年龄 61 岁；62%为男性）。有一定比例（12%）的患者在基线时报告了有心理困扰的医院焦虑和抑郁量表评分。大多数（88%）患者完成了所有课程。参与者报告了对干预措施的高满意度（97%）、有用性（96%）和文化敏感性（95%）。干预组的心理困扰没有减少；然而，癌症相关应对方面的自我效能感有所提高（信息寻求：效应大小[ES]为 0.64；95%置信区间[CI]为 0.17，0.85；应对副作用：ES 为 0.69；95%CI 为 0.33，0.82；保持积极态度：ES 为 0.45；95%CI 为 0.19，0.79），与候补组相比。
基于 CBT 的干预措施在新加坡患者中是可行和可接受的。在这个基线困扰程度较低的样本中，没有足够的证据支持更大规模的试验。未来的工作应确定并针对那些最需要支持的人。
