Thompson Jake R, Gomes Lisa, Kouvelis Grace, Smith Andrea L, Lo Serigne N, Kasparian Nadine A, Saw Robyn P M, Dieng Mbathio, Seaman Linda, Martin Linda K, Guitera Pascale, Milne Donna, Schmid Helen, Cust Anne E, Bartula Iris
Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.
Melanoma Institute Australia, University of Sydney, Wollstonecraft, Australia.
Psychooncology. 2024 Dec;33(12):e70041. doi: 10.1002/pon.70041.
To investigate the effectiveness of the Melanoma Care Programme when implemented into routine clinical practice coupled with fear of cancer recurrence (FCR) screening and a stepped-care model of intervention delivery.
Using a Type-I hybrid effectiveness-implementation design, individuals with stage 0-II melanoma and a Fear of Cancer Recurrence Inventory FCR severity score of ≥ 13 were offered the Melanoma Care Programme. The programme included a psychoeducational booklet and 3 to 5 psychotherapeutic telehealth sessions with a clinical psychologist, timed around routine dermatological appointments. Multivariable linear mixed modelling was used to analyse the effect of the intervention at 1-week post-intervention on patient-reported outcomes, including FCR severity (primary outcome), symptoms of depression, anxiety, and stress, melanoma-related knowledge, and health-related quality of life.
One hundred and twelve participants completed the intervention from 146 participants screened for FCR. Adjusted multivariable linear mixed modelling demonstrated that participants who received the intervention reported a reduced FCR severity at 1-week post-intervention (mean change: -3.81 [95% CI: -4.67, -2.95], p < 0.001) compared to baseline. Participants also reported improvements in melanoma-related knowledge (mean change: 0.64 [95% CI: 0.13, 1.15], p = 0.014), depressive symptoms (mean change: -1.41 [95% CI: -1.92, -0.90], p < 0.001), anxiety (mean change: -1.05 [95% CI: -1.48, -0.61], p < 0.001), stress (mean change: -1.58 [95% CI: -2.22, -0.93], p < 0.001), and health-related quality of life (mean change: 4.05 [95% CI: 2.84, 5.26], p < 0.001).
The Melanoma Care Programme maintained effectiveness when implemented into routine clinical practice with the addition of FCR screening and a stepped care model of delivery.
This study is registered with the Australia and New Zealand Clinical Trials Register (ACTRN12621000145808).
研究黑色素瘤护理计划在纳入常规临床实践时，结合癌症复发恐惧（FCR）筛查及阶梯式护理干预模式的有效性。
采用I型混合有效性-实施设计，为0-II期黑色素瘤患者且癌症复发恐惧量表FCR严重程度评分≥13分的个体提供黑色素瘤护理计划。该计划包括一本心理教育手册以及与临床心理学家进行3至5次心理治疗远程医疗会话，安排在常规皮肤科预约就诊时间前后。采用多变量线性混合模型分析干预后1周对患者报告结局的影响，包括FCR严重程度（主要结局）、抑郁、焦虑和压力症状、黑色素瘤相关知识以及健康相关生活质量。
在146名接受FCR筛查的参与者中，112名完成了干预。调整后的多变量线性混合模型表明，与基线相比，接受干预的参与者在干预后1周报告FCR严重程度降低（平均变化：-3.81 [95%CI：-4.67，-2.95]，p<0.001）。参与者还报告黑色素瘤相关知识有所改善（平均变化：0.64 [95%CI：0.13，1.15]，p = 0.014）、抑郁症状（平均变化：-1.41 [95%CI：-1.92，-0.90]，p<0.001）、焦虑（平均变化：-1.05 [95%CI：-1.48，-0.61]，p<0.001）、压力（平均变化：-1.58 [95%CI：-2.22，-0.93]，p<0.001）以及健康相关生活质量（平均变化：4.05 [95%CI：2.84，5.26]，p<0.001）。
黑色素瘤护理计划在纳入常规临床实践并增加FCR筛查和阶梯式护理交付模式时保持了有效性。
本研究已在澳大利亚和新西兰临床试验注册中心注册（ACTRN12621000145808）。
