Badger Terry, Segrin Chris, Crane Tracy E, Chalasani Pavani, Arslan Waqas, Hadeed Mary, Cunicelli Nathan, Given Charles W, Sikorskii Alla
Advanced Nursing Practice and Science Division, University of Arizona College of Nursing, Tucson, AZ, USA.
University of Arizona Cancer Center, Tucson, AZ, USA.
J Cancer Surviv. 2024 Nov 29. doi: 10.1007/s11764-024-01723-y.
Three sequences of telephone symptom management interventions were tested on use of unscheduled health services among cancer survivors with depressive or anxiety symptoms during treatment (N = 334) and their informal caregivers (N = 333).
The three 12-week intervention sequences were as follows: (1) Symptom Management and Survivorship Handbook (SMSH), (2) a combined 8-week SMSH + Telephone Interpersonal Counseling (TIPC) followed by SMSH for 4 weeks, and (3) SMSH for 4 weeks followed by a combined SMSH + TIPC if no response to SMSH alone. Survivor-caregiver dyads were first randomized to SMSH or a combined SMSH + TIPC. If the survivor's depressive or anxiety symptoms persisted after 4 weeks of SMSH alone, the dyad was randomized the second time to continue with SMSH alone or TIPC was added to SMSH. All participants were assessed at baseline and 13 and 17 weeks. Health service use was compared between randomized groups and among the three sequences.
Survivors were 60.2 years of age, 79% were female, and 41% were Hispanic. Caregivers were 54.8 years of age; 67% were female. The significantly lower rate of emergency department (ED) or urgent care visits for survivors was found in the SMSH + TIPC intervention sequence compared to the SMSH alone in the second randomization and for the third intervention sequence compared to the first.
Adding TIPC to SMSH after week 4 when survivors experienced persisting depressive or anxiety symptoms reduced ED/urgent care visits compared to SMSH alone.
Managing depression and anxiety symptoms may help prevent ED/urgent care visits and worsening of other symptoms.
对三组电话症状管理干预措施进行测试，这些措施针对治疗期间有抑郁或焦虑症状的癌症幸存者（N = 334）及其非正式护理人员（N = 333）使用非预约医疗服务的情况。
三组为期12周的干预措施如下：（1）症状管理与生存手册（SMSH），（2）先进行8周的SMSH + 电话人际咨询（TIPC）组合，随后4周进行SMSH，以及（3）先进行4周的SMSH，若仅使用SMSH无效果则随后进行SMSH + TIPC组合。幸存者 - 护理人员二元组首先被随机分配至SMSH组或SMSH + TIPC组合组。若仅使用SMSH 4周后幸存者的抑郁或焦虑症状仍持续存在，则该二元组再次被随机分配，继续仅使用SMSH或在SMSH基础上加用TIPC。所有参与者在基线、第13周和第17周接受评估。比较随机分组组之间以及三组干预措施之间的医疗服务使用情况。
幸存者平均年龄为60.2岁，79%为女性，41%为西班牙裔。护理人员平均年龄为54.8岁；67%为女性。在第二次随机分组中，与仅使用SMSH相比，SMSH + TIPC干预组的幸存者急诊室（ED）或紧急护理就诊率显著更低；在第三次干预组中，与第一次相比，该就诊率也显著更低。
在幸存者抑郁或焦虑症状持续4周后，在SMSH基础上加用TIPC与仅使用SMSH相比，可减少ED/紧急护理就诊。
管理抑郁和焦虑症状可能有助于预防ED/紧急护理就诊以及其他症状的恶化。
