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意义中心疼痛应对技能训练:晚期癌症患者心理社会疼痛管理干预的初步可行性试验。

Meaning-Centered Pain Coping Skills Training: A Pilot Feasibility Trial of a Psychosocial Pain Management Intervention for Patients with Advanced Cancer.

机构信息

Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.

Center for the Study of Human Aging and Development, Duke University, Durham, North Carolina, USA.

出版信息

J Palliat Med. 2022 Jan;25(1):60-69. doi: 10.1089/jpm.2021.0081. Epub 2021 Aug 12.

Abstract

Pain from advanced cancer can greatly reduce patients' physical, emotional, and spiritual well-being. To examine the feasibility and acceptability of a behavioral pain management intervention, Meaning-Centered Pain Coping Skills Training (MCPC). This trial used a single-arm feasibility design. Thirty participants with stage IV solid tumor cancer, moderate-to-severe pain, and clinically elevated distress were enrolled from a tertiary cancer center in the United States. The manualized protocol was delivered across four 45- to 60-minute videoconference sessions. Feasibility and acceptability were assessed through accrual, session/assessment completion, intervention satisfaction, and coping skills usage. Participants completed validated measures of primary outcomes (i.e., pain severity, pain interference, and spiritual well-being) and secondary outcomes at baseline, post-intervention, and four-week follow-up. Eighty-eight percent (38/43) of patients who completed screening met inclusion criteria, and 79% (30/38) consented and completed baseline assessment. Sixty-seven percent (20/30) of participants were female (mean age = 57). Most participants were White/Caucasian (77%; 23/30) or Black/African American (17%; 5/30) with at least some college education (90%; 27/30). Completion rates for intervention sessions and both post-intervention assessments were 90% (27/30), 87% (26/30), and 77% (23/30), respectively. At the post-intervention assessment, participants reported a high degree of intervention satisfaction (mean = 3.53/4.00; SD = 0.46), and 81% (21/26) reported weekly use of coping skills that they learned. Participants also showed improvement from baseline on all primary outcomes and nearly all secondary outcomes at both post-intervention assessments. MCPC demonstrated strong feasibility and acceptability. Findings warrant further evaluation of MCPC in a randomized controlled trial. ClinicalTrials.gov Identifier: NCT03207360.

摘要

晚期癌症引起的疼痛会极大地降低患者的身体、情感和精神健康。为了检验一种行为疼痛管理干预措施——以意义为中心的疼痛应对技能训练(MCPC)的可行性和可接受性,本试验采用了单臂可行性设计。30 名来自美国一家三级癌症中心的患有 IV 期实体瘤癌症、中重度疼痛和临床显著焦虑的参与者参与了本试验。这个方案经过了 4 次 45 到 60 分钟的视频会议。通过入组、课程/评估完成、干预满意度和应对技能使用来评估可行性和可接受性。参与者在基线、干预后和四周随访时完成了主要结局(即疼痛严重程度、疼痛干扰和精神健康)和次要结局的有效验证。88%(43 名患者中的 38 名)完成了筛选符合纳入标准,且 79%(38 名中的 30 名)同意并完成了基线评估。30 名参与者中有 67%(20 名)为女性(平均年龄 57 岁)。大多数参与者为白种人/高加索人(77%;23 名中的 20 名)或非裔美国人(17%;23 名中的 5 名),至少受过一些大学教育(90%;27 名中的 23 名)。干预课程和两次干预后评估的完成率分别为 90%(30 名中的 27 名)、87%(30 名中的 26 名)和 77%(30 名中的 23 名)。在干预后评估时,参与者报告了很高的干预满意度(平均 3.53/4.00;标准差 0.46),81%(26 名中的 21 名)报告每周使用他们所学的应对技能。在两次干预后评估时,参与者在所有主要结局和几乎所有次要结局上都较基线有了改善。MCPC 表现出很强的可行性和可接受性。这些发现证明了在随机对照试验中进一步评估 MCPC 的必要性。ClinicalTrials.gov 标识符:NCT03207360。

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