Pilot Randomized Controlled Trial of Individual Meaning-Centered Psychotherapy for Patients With Advanced Cancer
Pilot Randomized Controlled Trial of Individual Meaning-Centered Psychotherapy for Patients With Advanced Cancer
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DOI：
10.1200/jco.2011.36.2517
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发表时间：
2012-04-20
影响因子：
45.3
通讯作者：
Cassileth, Barrie R.
中科院分区：
文献类型：
--
作者：
Breitbart, William;Poppito, Shannon;Cassileth, Barrie R.
目的精神幸福感和意义感是护理癌症患者的临床医生的重要关注点。我们开发了以个体意义为中心的心理治疗(IMCP)，以满足针对晚期癌症患者精神健康和意义的简短干预的需要。患者和方法III或IV期癌症患者(N=120)被随机分配到IMCP或治疗性按摩(TM)的7个疗程。分别在干预前、干预结束后和干预后2个月进行评估。结果在随机分配的120名参与者中，78名(65%)完成了治疗后的评估，67名(56%)完成了为期2个月的随访。在治疗后评估中，IMCP参与者在精神健康的主要结果(b=0.39；P<；.001)和生活质量(b=0.76；P=.013)和生活质量(b=0.76；P=.013)方面的改善显著高于对照条件。IMCP患者的症状负担(b=-6.56；P&t；.001)和与症状相关的苦恼(b=-0.47；P<；.001)的次要结果也有显著改善，但焦虑、抑郁或绝望没有改善。在2个月的随访评估中，IMCP组的改善不再明显大于TM组。结论IMCP对晚期癌症患者的精神痛苦和生活质量有明显的短期益处。治疗晚期癌症患者的临床医生应该考虑将IMCP作为一种提高生活质量和精神健康的方法。
PurposeSpiritual well-being and sense of meaning are important concerns for clinicians who care for patients with cancer. We developed Individual Meaning-Centered Psychotherapy (IMCP) to address the need for brief interventions targeting spiritual well-being and meaning for patients with advanced cancer.Patients and MethodsPatients with stage III or IV cancer (N = 120) were randomly assigned to seven sessions of either IMCP or therapeutic massage (TM). Patients were assessed before and after completing the intervention and 2 months postintervention. Primary outcome measures assessed spiritual well-being and quality of life; secondary outcomes included anxiety, depression, hopelessness, symptom burden, and symptom-related distress.ResultsOf the 120 participants randomly assigned, 78 (65%) completed the post-treatment assessment and 67 (56%) completed the 2-month follow-up. At the post-treatment assessment, IMCP participants demonstrated significantly greater improvement than the control condition for the primary outcomes of spiritual well-being (b = 0.39; P < .001, including both components of spiritual well-being (sense of meaning: b = 0.34; P = .003 and faith: b = 0.42; P = .03), and quality of life (b = 0.76; P = .013). Significantly greater improvements for IMCP patients were also observed for the secondary outcomes of symptom burden (b = -6.56; P < .001) and symptom-related distress (b = -0.47; P < .001) but not for anxiety, depression, or hopelessness. At the 2-month follow-up assessment, the improvements observed for the IMCP group were no longer significantly greater than those observed for the TM group.ConclusionIMCP has clear short-term benefits for spiritual suffering and quality of life in patients with advanced cancer. Clinicians working with patients who have advanced cancer should consider IMCP as an approach to enhance quality of life and spiritual well-being.