将姑息治疗融入乳腺癌自我管理中：一项试点随机对照试验。
Integrating Palliative Care Into Self-management of Breast Cancer: A Pilot Randomized Controlled Trial.
机构信息
Author Affiliations: New York University Rory Meyers College of Nursing (Dr Schulman-Green); Yale School of Nursing (Ms Linsky and Dr Jeon), Yale School of Medicine (Drs Holland and Chagpar), and Smilow Cancer Hospital (Drs Kapo and Chagpar and Ms Blatt), West Haven, Connecticut; and St Peters Hospital, Albany, New York (Dr Adams).
出版信息
Cancer Nurs. 2023;46(3):E169-E180. doi: 10.1097/NCC.0000000000001078. Epub 2022 Dec 1.
BACKGROUND
Breast cancer patients may not be well-informed about palliative care, hindering its integration into cancer self-management.
OBJECTIVE
The aim of this study was to test Managing Cancer Care: A Personal Guide (MCC-PT), an intervention to improve palliative care literacy and cancer self-management.
METHODS
This was a single-blind pilot randomized controlled trial to evaluate the feasibility/acceptability and intervention effects of MCC-PT on palliative care literacy, self-management behaviors/emotions, and moderation by demographic/clinical characteristics. We enrolled 71 stages I to IV breast cancer patients aged at least 21 years, with >6-month prognosis at an academic cancer center. Patients were randomized to MCC-PT (n = 32) versus symptom management education as attention-control (n = 39). At baseline, 1 month, and 3 months, participants completed the Knowledge of Care Options Test (primary outcome), Control Preferences Scale, Goals of Care Form, Medical Communication Competence Scale, Measurement of Transitions in Cancer Scale, Chronic Disease Self-efficacy Scale, Hospital Anxiety and Depression Scale, and the Mishel Uncertainty in Illness Scale.
RESULTS
Mean participant age was 51.5 years (range, 28-74 years); 53.5% were racial/ethnic minority patients, and 40.8% had stage III/IV cancer. After adjusting for race/ethnicity, MCC-PT users improved their palliative care literacy with a large effect size (partial η2 = 0.13). Patients at late stage of disease showed increased self-management (partial η2 = 0.05) and reduced anxiety (partial η2 = 0.05) and depression (partial η2 = 0.07) with medium effect sizes.
CONCLUSIONS
Managing Cancer Care: A Personal Guide is feasible and appears most effective in late-stage cancer. Research is needed to elucidate relationships among cancer stage, race/ethnicity, and self-management outcomes.
IMPLICATIONS FOR PRACTICE
Integration of palliative care into cancer care can assist in creation of appropriate self-management plans and improve emotional outcomes.
背景
乳腺癌患者可能对姑息治疗了解不足，这阻碍了姑息治疗融入癌症自我管理。
目的
本研究旨在测试《管理癌症护理：个人指南》（MCC-PT），这是一种提高姑息治疗知识和癌症自我管理的干预措施。
方法
这是一项单盲随机对照试验，旨在评估 MCC-PT 的姑息治疗知识、自我管理行为/情绪的可行性/可接受性和干预效果，以及人口统计学/临床特征的调节作用。我们招募了 71 名年龄至少 21 岁、预计生存时间超过 6 个月的 I 至 IV 期乳腺癌患者，他们在一家学术癌症中心接受治疗。患者被随机分配至 MCC-PT 组（n = 32）或症状管理教育组（对照组，n = 39）。在基线、1 个月和 3 个月时，参与者完成了护理选项知识测试（主要结局）、控制偏好量表、护理目标表单、医疗沟通能力量表、癌症过渡期测量量表、慢性病自我效能感量表、医院焦虑和抑郁量表以及米舍尔疾病不确定感量表。
结果
参与者的平均年龄为 51.5 岁（范围，28-74 岁）；53.5%为少数民族患者，40.8%为 III/IV 期癌症患者。调整种族/民族因素后，MCC-PT 用户的姑息治疗知识提高，具有较大的效应量（偏η2 = 0.13）。晚期疾病患者的自我管理能力提高（偏η2 = 0.05），焦虑（偏η2 = 0.05）和抑郁（偏η2 = 0.07）情绪减轻，具有中等效应量。
结论
《管理癌症护理：个人指南》是可行的，在晚期癌症中效果最为明显。需要进一步研究以阐明癌症分期、种族/民族和自我管理结果之间的关系。
意义
姑息治疗融入癌症护理可以帮助制定适当的自我管理计划，并改善情绪结果。
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