实施由护士提供的认知行为疗法干预措施以减轻潮热/盗汗对乳腺癌女性的影响：MENOS4试验的定性过程评估

Implementing a nurse-delivered cognitive behavioural therapy intervention to reduce the impact of hot flushes/night sweats in women with breast cancer: a qualitative process evaluation of the MENOS4 trial.

作者信息

Boxall Cherish, Fenlon Deborah, May Carl, Nuttall Jacqui, Hunter Myra S

机构信息

Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK.

Department of Nursing, School of Health and Social Care, Faculty of Medicine, Health and Life Science, University of Swansea, Swansea, UK.

出版信息

BMC Nurs. 2023 Sep 15;22(1):317. doi: 10.1186/s12912-023-01441-3.

DOI:10.1186/s12912-023-01441-3

PMID:37715249

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10503156/

Abstract

BACKGROUND

Hot flushes and night sweats are life-altering symptoms experienced by many women after breast cancer treatment. A randomised controlled trial (RCT) was conducted to explore the effectiveness of breast care nurse (BCN)-led group cognitive behavioural therapy (CBT). This paper reported findings from a qualitative process evaluation to optimise the CBT intervention and explore the determinants of implementation into routine practice.

METHODS

Qualitative process evaluation occurred in parallel with the RCT to explore patient and healthcare staff experiences and perspectives using semi-structured interviews pre-and post-intervention. Normalisation Process Theory (NPT) informed data collection, analysis, and reporting of findings. The analysis involved inductive thematic analysis, NPT coding manual and subsequent mapping onto NPT constructs.

RESULTS

BCNs (n = 10), managers (n = 2), surgeons (n = 3) and trial participants (n = 8) across six recruiting sites took part. All stakeholders believed group CBT met a need for non-medical hot flushes/night sweats treatment, however, had little exposure or understanding of CBT before MENOS4. BCNs believed the work fitted with their identity and felt confident in delivering the sessions. Despite little understanding, patients enrolled onto group CBT because the BCNs were trusted to have the knowledge and understanding to support their needs and despite initial scepticism, reported great benefit from group-based participation. Both managers and surgeons were keen for BCNs to take responsibility for all aspects of CBT delivery, but there were some tensions with existing clinical commitments and organisational priorities.

CONCLUSIONS

Both healthcare staff and patient participants believe BCN-led group CBT is a beneficial service but barriers to long-term implementation into routine care suggest there needs to be multi-level organisational support.

TRIAL REGISTRATION

NCT02623374 - Last updated 07/12/2015 on ClinicalTrials.gov PRS.

摘要

背景

潮热和盗汗是许多女性在乳腺癌治疗后经历的改变生活的症状。开展了一项随机对照试验（RCT）以探究由乳腺护理护士（BCN）主导的团体认知行为疗法（CBT）的有效性。本文报告了一项定性过程评估的结果，以优化CBT干预措施并探索将其纳入常规实践的决定因素。

方法

定性过程评估与RCT同步进行，通过干预前后的半结构化访谈来探究患者和医护人员的经历及观点。正常化过程理论（NPT）为数据收集、分析和结果报告提供了指导。分析包括归纳主题分析、NPT编码手册以及随后映射到NPT结构上。

结果

来自六个招募地点的10名BCN、2名管理人员、3名外科医生和8名试验参与者参与其中。所有利益相关者都认为团体CBT满足了非药物治疗潮热/盗汗的需求，然而，在参与MENOS4之前，他们对CBT几乎没有接触或了解。BCN认为这项工作符合他们的身份，并且对开展课程充满信心。尽管了解不多，但患者报名参加团体CBT是因为他们信任BCN具备支持其需求的知识和理解，并且尽管最初持怀疑态度，但他们报告称基于团体的参与带来了很大益处。管理人员和外科医生都渴望BCN对CBT实施的各个方面负责，但与现有的临床工作和组织优先事项存在一些矛盾。