Graduate School of Clinical Psychology, Teikyo Heisei University.
Department of Medical Psychology, Nippon Medical School.
J Nippon Med Sch. 2022;89(4):428-435. doi: 10.1272/jnms.JNMS.2022_89-410.
In Japan, little is known of the severity of and factors associated with psychological distress among caregivers of patients with advanced or recurrent cancer who die.
This prospective cohort study of cancer patients at the National Cancer Center Hospital East, Japan, and their caregivers followed the participants from the initial palliative care consultation (T1) to 6 months (T2) and 13 months (T3) after the patient's death. At T1, patients and caregivers were interviewed separately. After T1, telephone interviews were conducted periodically, and a mail survey was distributed at T2 and T3. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, and the Distress and Impact Thermometer (DIT) was used to screen for psychological distress. Items on end-of-life attitudes, including awareness, discussion, and willingness of cancer care and death, were developed.
Thirty-one of 86 eligible pairs participated in this study. The participation rate was low (36%) and enrollment was thus halted. Data were collected up to T3 for 22 pairs (completion rate 71%). PHQ-9 scores at T2 and T3 were higher than at T1, but the difference was not significant (p = 0.07). PHQ-9 score at T3 was significantly associated with caregiver PHQ-9 and distress at T1, with patient distress and impact at T1, and with caregiver health problems at T2.
Caregiver depression persisted up to 13 months after the patient's death, which suggests that pre-bereavement screening with the DIT might be useful. The present paired enrollment process requires improvement.
在日本，对于在临终关怀咨询时（T1）处于晚期或复发性癌症的患者及其照顾者，在患者去世后 6 个月（T2）和 13 个月（T3）时，他们的心理困扰的严重程度和相关因素知之甚少。
这项针对日本国家癌症中心东医院癌症患者及其照顾者的前瞻性队列研究，在患者初始姑息治疗咨询（T1）时对患者和照顾者进行了单独访谈。之后，定期进行电话访谈，并在 T2 和 T3 时发送邮件调查。采用患者健康问卷-9（PHQ-9）评估抑郁，采用痛苦和影响温度计（DIT）筛查心理困扰。制定了临终态度的项目，包括对癌症护理和死亡的意识、讨论和意愿。
在 86 对符合条件的患者和照顾者中，有 31 对参与了本研究。参与率很低（36%），因此停止了入组。为 22 对患者收集了截止到 T3 的数据（完成率 71%）。T2 和 T3 的 PHQ-9 评分高于 T1，但差异无统计学意义（p = 0.07）。T3 的 PHQ-9 评分与 T1 时照顾者的 PHQ-9 和痛苦、患者的痛苦和影响以及 T2 时照顾者的健康问题显著相关。
患者去世后 13 个月，照顾者仍存在抑郁，这表明在哀伤前使用 DIT 进行筛查可能有用。目前的配对入组流程需要改进。
