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远程医疗提供自杀特定团体治疗“生命力量项目”的定性研究

Qualitative Study of Telehealth Delivery of Suicide-Specific Group Treatment "Project Life Force".

作者信息

Patel Sapana R, Sullivan Sarah R, Mitchell Emily L, Jager-Hyman Shari, Stanley Barbara, Goodman Marianne

机构信息

The New York State Psychiatric Institute, New York, NY USA.

Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 100, New York, NY 10032 USA.

出版信息

J Technol Behav Sci. 2023 Jan 4:1-10. doi: 10.1007/s41347-022-00297-9.

Abstract

Minimal evidence exists for suicide-specific group treatment for high-risk patients offered over telehealth. This qualitative study assessed the acceptability, feasibility, and impact of a telehealth suicide safety planning intervention (SPI) multi-session group. High-risk suicidal Veterans ( = 17) participating in "Project Life Force-telehealth" (PLF-T); a manualized, 10-session SPI video group completed semi-structured qualitative interviews including measures of acceptability, appropriateness, and feasibility. We also interviewed the PLF-T coordinator and PLF-T group facilitators to identify adaptations to deliver PLF-T and learn about barriers and facilitators to implementation. A summary template and matrix analysis approach was used to analyze qualitative data. Veteran group participants were mostly male (88%), age 50 (SD = 15.6), ethnically diverse, and either divorced or separated (54%). Suicide symptoms upon study entry included past month ideation with methods (100%); and past year aborted, interrupted, or actual suicide attempt (59%). Participant interviews revealed an overall positive endorsement of PLF-telehealth with enhanced suicidal disclosure, and improved ability to manage urges and mitigate loneliness. On scales from 1 to 20, PLF-T was rated as highly acceptable (M = 17.50; SD = 2.92), appropriate (M = 17.25; SD = 3.59), and feasible (M = 18; SD = 2.45) by participants. Adaptations to deliver PLF-T included using a communications coordinator to conduct assertive outreach and engagement, adding a telehealth orientation session, restructuring sessions to review suicide severity, and screen-sharing safety plans to maximize learning. PLF-T enhanced convenience and access without compromising safety. Concerns included privacy and technological limitations including connectivity. Project Life Force-telehealth is acceptable and feasible to deliver via telehealth. This opens the possibility of delivery to hard-to-reach high-risk populations. ClinicalTrials.gov Identifier: NCT0365363.

摘要

关于通过远程医疗为高危患者提供自杀特定群体治疗的证据极少。这项定性研究评估了远程医疗自杀安全计划干预(SPI)多环节小组治疗的可接受性、可行性和影响。参与“生命力量-远程医疗项目”(PLF-T)的高危自杀退伍军人(n = 17);一个采用手册化、10环节SPI视频小组治疗的项目,完成了半结构化定性访谈,包括可接受性、适宜性和可行性的测量。我们还采访了PLF-T协调员和PLF-T小组 facilitators,以确定实施PLF-T的调整措施,并了解实施的障碍和促进因素。采用总结模板和矩阵分析方法对定性数据进行分析。退伍军人小组参与者大多为男性(88%),年龄50岁(标准差 = 15.6),种族多样,且离婚或分居(54%)。研究开始时的自杀症状包括过去一个月有自杀意念及方法(100%);以及过去一年有未遂、中断或实际自杀企图(59%)。参与者访谈显示总体上对PLF-远程医疗持积极认可态度,自杀披露增加,控制冲动和减轻孤独的能力有所提高。在1至20的量表上,参与者对PLF-T的评价为高度可接受(M = 17.50;标准差 = 2.92)、适宜(M = 17.25;标准差 = 3.59)和可行(M = 18;标准差 = 2.45)。实施PLF-T的调整措施包括使用通信协调员进行积极的外展和参与,增加远程医疗入门环节,重新组织环节以审查自杀严重程度,以及共享安全计划屏幕以最大化学习效果。PLF-T提高了便利性和可及性,同时不影响安全性。担忧包括隐私和技术限制,包括连接性。生命力量-远程医疗项目通过远程医疗实施是可接受和可行的。这为向难以接触到的高危人群提供治疗开辟了可能性。ClinicalTrials.gov标识符:NCT0365363 。 (注:“facilitators”未找到合适中文对应词,保留英文)

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