Department of Psychiatry, Center for Mindfulness, Radboud University Medical Center, Nijmegen, Netherlands.
Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.
J Med Internet Res. 2020 Oct 2;22(10):e17526. doi: 10.2196/17526.
One in three cancer patients experience high psychological distress. Mindfulness-based interventions are effective in reducing psychological distress in this patient group. However, these interventions lack availability and flexibility, which may compromise participation in the intervention for cancer patients experiencing late symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via the internet. However, little is known about the usage of these online mindfulness-based interventions.
The aim of this study was to (1) predict uptake of and adherence to online mindfulness-based cognitive therapy (eMBCT) using baseline patient characteristics (demographic, cancer-related, personality, and psychological variables) and (2) examine the relations between adherence and treatment outcomes in eMBCT for cancer patients.
A total of 125 cancer patients were assigned to eMBCT in a parent randomized controlled trial comparing MBCT and eMBCT with treatment as usual in distressed cancer patients. Various usage measures of eMBCT were automatically tracked within the online program. Based on activity of use, participants were classified as nonusers, minimal users, low users, and intended users. Questionnaires were used to assess baseline characteristics (preintervention) and outcomes (pre- and postintervention). To answer the research questions, data were analyzed with t tests, χ tests, and linear regression models.
Based on weekly activity, participants were classified as nonusers (n=17, 13.6%), who completed no exercises in MBCT; minimal users (n=31, 24.8%), who completed at least one exercise of one to three sessions; low users (n=12, 9.6%), who completed at least one exercise of four to seven sessions; and intended users (n=65, 52.0%), who completed at least one exercise of eight to nine sessions. Nonusers had more fear of cancer recurrence at baseline than users (uptake), and intended users were more conscientious than minimal and low users (adherence). Intended users reported a larger reduction in psychological distress and more improvement of positive mental health (ie, emotional, psychological, and social well-being) after the intervention than other participants.
This study showed that adherence was related to improved patient outcomes. Patients with strong fear of recurrence or low levels of conscientiousness should receive extra attention, as they are less likely to respectively start or complete eMBCT. Future research may focus on the development of flexible and adaptive eMBCT programs to fit individual needs.
三分之一的癌症患者经历高度心理困扰。基于正念的干预措施在减轻这组患者的心理困扰方面是有效的。然而，这些干预措施缺乏可用性和灵活性，这可能会影响癌症患者对干预措施的参与，因为他们可能会出现疲劳或疼痛等晚期症状。因此，基于正念的干预措施越来越多地通过互联网提供。然而，对于这些在线基于正念的干预措施的使用情况知之甚少。
本研究旨在：（1）使用基线患者特征（人口统计学、癌症相关、个性和心理变量）预测在线基于正念的认知疗法（eMBCT）的接受度和依从性；（2）检查癌症患者接受 eMBCT 治疗后的依从性与治疗结果之间的关系。
共有 125 名癌症患者被分配到一项家长式随机对照试验中的 eMBCT 组，该试验比较了 MBCT 和 eMBCT 与常规治疗对有心理困扰的癌症患者的效果。各种 eMBCT 的使用措施在在线程序中自动进行跟踪。根据活动使用情况，参与者被分为非使用者、最低使用者、低使用者和意向使用者。使用问卷评估基线特征（干预前）和结果（干预前和干预后）。为了回答研究问题，使用 t 检验、χ 检验和线性回归模型进行数据分析。
根据每周的活动情况，参与者被分为非使用者（n=17，占 13.6%），他们没有完成 MBCT 的任何练习；最低使用者（n=31，占 24.8%），他们完成了至少一个一到三节课的练习；低使用者（n=12，占 9.6%），他们完成了至少一个四到七节课的练习；和意向使用者（n=65，占 52.0%），他们完成了至少一个八到九节课的练习。非使用者在基线时比使用者（接受度）更害怕癌症复发，意向使用者比最低和低使用者更尽责（依从性）。与其他参与者相比，意向使用者在干预后报告的心理困扰减少更大，积极心理健康（即情绪、心理和社会幸福感）改善更多。
本研究表明，依从性与改善患者结局相关。具有强烈恐惧复发或尽责性较低的患者应得到额外关注，因为他们不太可能开始或完成 eMBCT。未来的研究可能集中于开发灵活和适应的 eMBCT 方案，以满足个人需求。
