Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, United States; Fordham University, 441 East Fordham Road, Dealy 226, Bronx, NY, United States.
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, United States.
J Geriatr Oncol. 2022 Jun;13(5):706-714. doi: 10.1016/j.jgo.2022.02.009. Epub 2022 Mar 2.
The Cancer and Aging: Reflections for Elders Expressive Writing Intervention (CARE-Express) was developed to enhance coping and minimize psychological distress in older adults with cancer. The aim of the current study is to evaluate the feasibility and initial efficacy of CARE-Express.
Seventy-one distressed older adults (≥70) with cancer were assigned to CARE-Express (n = 41) or the Enhanced Social Work Control (ESWC) arm (n = 30). Participants completed five telephone sessions over seven weeks and were assessed on psychosocial variables at baseline, post-intervention, and four months post study enrollment. Feasibility was assessed by examining rates of eligibility, acceptance, retention, assessment, and fidelity. Initial efficacy was evaluated using standardized effect sizes.
Adequate rates of acceptance (29%), eligibility (66%), retention (90%), assessment (70% at post-intervention, 63% at four month follow-up), and fidelity (97%) were observed. At post-intervention, participants receiving CARE-Express reported less depression compared to ESWC (d = 0.69, p = 0.01) and lower demoralization (d = 0.50, p = 0.06). A small/moderate effect was demonstrated for increased total spirituality scores (d = 0.41, p = 0.07), meaning/peace (d = 0.32, p = 0.20) and faith (d = 0.35, p = 0.07). The CARE-Express group reported greater reductions in behavioral disengagement (d = 0.44, p = 0.06), while ESWC demonstrated a small effect for active coping (d = 0.21, p = 0.31). At four months, differential effects of CARE-Express had attenuated, though small/moderate, effects in favor of CARE-Express remained.
Results support the feasibility of CARE-Express and its potential positive impact on psychological well-being.
Registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT00984321 on September 25, 2009.
癌症与衰老：老年人表达性写作干预（CARE-Express）的开发旨在增强老年癌症患者的应对能力并减轻其心理困扰。本研究旨在评估 CARE-Express 的可行性和初步疗效。
71 名患有癌症的焦虑老年患者（≥70 岁）被分配至 CARE-Express（n = 41）或增强型社会工作对照组（n = 30）。参与者在七周内完成五次电话会议，并在基线、干预后和研究入组后四个月评估心理社会变量。通过评估资格、接受率、保留率、评估和保真度来评估可行性。使用标准化效应量评估初步疗效。
接受率（29%）、资格率（66%）、保留率（90%）、评估率（干预后 70%，四个月随访时 63%）和保真度（97%）均较高。干预后，与增强型社会工作对照组相比，接受 CARE-Express 的患者报告抑郁症状减轻（d = 0.69，p = 0.01），同时沮丧程度降低（d = 0.50，p = 0.06）。结果显示，总灵性评分（d = 0.41，p = 0.07）、意义/平静（d = 0.32，p = 0.20）和信仰（d = 0.35，p = 0.07）均呈中等程度增加。CARE-Express 组报告行为脱离的减少更大（d = 0.44，p = 0.06），而增强型社会工作对照组的积极应对则显示出较小的效果（d = 0.21，p = 0.31）。在四个月时，CARE-Express 的差异影响减弱，但仍显示出有利于 CARE-Express 的小/中度效果。
结果支持 CARE-Express 的可行性及其对心理健康的潜在积极影响。
于 2009 年 9 月 25 日在美国国立卫生研究院（ClinicalTrials.gov）注册 #NCT00984321。
