针对乳腺癌患者的阶梯式数字心理社会干预中的治疗联盟：一项多中心随机对照试验的结果
Therapeutic alliance in a stepped digital psychosocial intervention for breast cancer patients: findings from a multicentre randomised controlled trial.
作者信息
Flix-Valle Aida, Medina Joan Carles, Souto-Sampera Arnau, Arizu-Onassis Alejandra, Juan-Linares Eva, Serra-Blasco Maria, Ciria-Suárez Laura, Feixas Guillem, Ochoa-Arnedo Cristian
机构信息
ICOnnecta't Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain; Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain; and Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain.
ICOnnecta't Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain; Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain; and Department of Psychology and Education Sciences, Universitat Oberta de Catalunya, Spain.
出版信息
BJPsych Open. 2025 Jan 27;11(1):e23. doi: 10.1192/bjo.2024.844.
BACKGROUND
Action mechanisms of therapeutic alliance in stepped and digital interventions remain unclear.
AIMS
(a) To compare the development of therapeutic alliance between psychosocial treatment as usual (PTAU) and a stepped digital intervention designed to prevent distress in cancer patients; (b) to analyse the level of agreement between patients' and therapists' therapeutic alliance ratings; and (c) to explore variables associated with therapeutic alliance in the digital intervention.
METHOD
A multicentre randomised controlled trial with 184 newly diagnosed breast cancer women was conducted. Patients were assigned to digital intervention or PTAU. Therapeutic alliance was assessed at 3, 6 and 12 months after inclusion using the working alliance inventory for patients and therapists. Age, usability (system usability scale), satisfaction (visual analogue scale), type and amount of patient-therapist communication were analysed as associated variables.
RESULTS
Patients and therapists established high therapeutic alliance in the digital intervention, although significantly lower compared with PTAU. The development of patients' therapeutic alliance did not differ between interventions, unlike that of the therapists. No agreement was found between patients' and therapists' therapeutic alliance ratings. Patients' therapeutic alliance was associated with usability and satisfaction with app, whereas therapists' therapeutic alliance was associated with satisfaction with monitoring platform.
CONCLUSIONS
A stepped digital intervention for cancer patients could develop and maintain strong therapeutic alliance. Neither the type nor amount of communication affected patients' therapeutic alliance, suggesting that flexible and available digital communication fosters a sense of care and connection. The association between usability and satisfaction with digital tools highlights their importance as key therapeutic alliance components in digital settings.
背景
在分级和数字化干预中，治疗联盟的作用机制尚不清楚。
目的
（a）比较常规心理社会治疗（PTAU）与旨在预防癌症患者痛苦的分级数字化干预之间治疗联盟的发展情况；（b）分析患者和治疗师对治疗联盟评分的一致性水平；（c）探索数字化干预中与治疗联盟相关的变量。
方法
对184名新诊断的乳腺癌女性进行了一项多中心随机对照试验。患者被分配到数字化干预组或PTAU组。在纳入研究后的3个月、6个月和12个月，使用患者和治疗师工作联盟量表评估治疗联盟。将年龄、可用性（系统可用性量表）、满意度（视觉模拟量表）、患者与治疗师沟通的类型和数量作为相关变量进行分析。
结果
在数字化干预中，患者和治疗师建立了较高的治疗联盟，尽管与PTAU相比显著较低。不同干预措施下患者治疗联盟的发展没有差异，但治疗师的情况不同。患者和治疗师对治疗联盟的评分之间没有一致性。患者的治疗联盟与应用程序的可用性和满意度相关，而治疗师的治疗联盟与对监测平台的满意度相关。
结论
针对癌症患者的分级数字化干预可以建立并维持强大的治疗联盟。沟通的类型和数量均未影响患者的治疗联盟，这表明灵活且随时可用的数字化沟通能增强关怀感和联系感。数字化工具的可用性与满意度之间的关联凸显了它们作为数字化环境中治疗联盟关键组成部分的重要性。
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