Shedden-Mora Meike C, Pan Yiqi, Heisig Sarah R, von Blanckenburg Pia, Rief Winfried, Witzel Isabell, Albert Ute-Susann, Nestoriuc Yvonne
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Clinical Psychology and Psychotherapy, Hamburg University, Hamburg, Germany.
Clin Psychol Eur. 2020 Mar 31;2(1):e2695. doi: 10.32872/cpe.v2i1.2695. eCollection 2020 Mar.
Medication side effects are strongly determined by non-pharmacological, nocebo mechanisms, particularly patients' expectations. Optimizing expectations could minimize side effect burden. This study evaluated whether brief psychological expectation management training (EXPECT) optimizes medication-related expectations in women starting adjuvant endocrine therapy (AET) for breast cancer.
In a multisite randomized controlled design, 197 women were randomized to EXPECT, supportive therapy (SUPPORT), or treatment as usual (TAU). The three-session cognitive-behavioral EXPECT employs psychoeducation, guided imagery, and side effect management training. Outcomes were necessity-concern beliefs about AET, expected side effects, expected coping ability, treatment control expectations, and adherence intention.
Both interventions were well accepted and feasible. Patients' necessity-concern beliefs were optimized in EXPECT compared to both TAU and SUPPORT, d = .41, p < .001; d = .40, p < .001. Expected coping ability and treatment control expectations were optimized compared to TAU, d = .35, p = .02; d = .42, p < 001, but not to SUPPORT. Adherence intention was optimized compared to SUPPORT, d = .29, p = .02, but not to TAU. Expected side effects did not change significantly.
Expectation management effectively and partly specifically (compared to SUPPORT) modified medication-related expectations in women starting AET. Given the influence of expectations on long-term treatment outcome, psychological interventions like EXPECT might provide potential pathways to reduce side effect burden and improve quality of life during medication intake.
药物副作用很大程度上由非药理学的、反安慰剂机制决定，尤其是患者的期望。优化期望可将副作用负担降至最低。本研究评估了简短的心理期望管理训练（EXPECT）是否能优化开始接受乳腺癌辅助内分泌治疗（AET）的女性与药物相关的期望。
在一项多中心随机对照设计中，197名女性被随机分配至EXPECT组、支持性治疗（SUPPORT）组或常规治疗（TAU）组。为期三节课的认知行为EXPECT训练采用了心理教育、引导式意象和副作用管理训练。结果指标包括对AET的必要性-关注信念、预期副作用、预期应对能力、治疗控制期望和依从意愿。
两种干预措施均被很好地接受且可行。与TAU组和SUPPORT组相比，EXPECT组患者的必要性-关注信念得到了优化，d = 0.41，p < 0.001；d = 0.40，p < 0.001。与TAU组相比，预期应对能力和治疗控制期望得到了优化，d = 0.35，p = 0.02；d = 0.42，p < 0.001，但与SUPPORT组相比未得到优化。与SUPPORT组相比，依从意愿得到了优化，d = 0.29，p = 0.02，但与TAU组相比未得到优化。预期副作用没有显著变化。
期望管理有效且部分具有特异性（与SUPPORT组相比）地改变了开始接受AET治疗的女性与药物相关的期望。鉴于期望对长期治疗结果的影响，像EXPECT这样的心理干预可能为减轻副作用负担和改善药物治疗期间的生活质量提供潜在途径。
