A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: effects on distress.
A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: effects on distress.
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DOI：
10.1038/bmt.2015.104
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发表时间：
2015-08
影响因子：
4.8
通讯作者：
Mikulich-Gilbertson SK
中科院分区：
文献类型：
--
作者：
Laudenslager ML;Simoneau TL;Kilbourn K;Natvig C;Philips S;Spradley J;Benitez P;McSweeney P;Mikulich-Gilbertson SK
接受同种异体造血干细胞移植（alloo - hsct）的患者的护理人员在患者护理中起着关键作用，但结果却面临着高压力、焦虑和抑郁。我们推测，与常规治疗（TAU）相比，适用于Allo-HSCT护理人员的压力管理可以减少痛苦。从267名Allo-HSCT患者的连续护理人员中，148名（平均53.5岁，75.7%为女性）被随机分配到社会心理干预组（n=74）或TAU组（n=74）。移植后100天内进行了8次1对1的压力管理课程，重点是理解压力、改变照顾者的角色、认知行为压力管理、调节呼吸和识别社会支持。主要结局包括感知压力（心理）和唾液皮质醇觉醒反应（CAR）（生理）。随机分组在基线时无统计学差异。混合模型协方差分析（意向-治疗）显示，与TAU （Mean=23.0, CI95=21.0-25.0）相比，干预与移植后3个月的照顾者压力（Mean=20.0, CI95=17.9-22.0）显著降低相关，效应量（ES）为0.39 （p=0.039）。包括抑郁和焦虑在内的次要心理结局显著降低，ESs分别为0.46和0.66。护理人员的CAR在基线时与非护理对照组没有差异，并且在干预后没有变化。尽管有很大的照顾负担，这种心理社会干预显着减轻了异位造血干细胞移植照顾者的痛苦。
Caregivers of patients receiving allogeneic hematopoietic stem cell transplants (Allo-HSCT) serve a pivotal role in patient care but experience high stress, anxiety, and depression as a result. We theorized that a stress management adapted for Allo-HSCT caregivers would reduce distress compared to treatment as usual (TAU). From 267 consecutive caregivers of Allo-HSCT patients approached, 148 (mean=53.5 years, 75.7% female) were randomized to either psychosocial intervention (n=74) or TAU (n=74). Eight 1-on-1 stress management sessions delivered across the 100 day post-transplant period focused on understanding stress, changing role(s) as caregiver, cognitive behavioral stress management, pacing respiration, and identifying social support. Primary outcomes included perceived stress (psychological) and salivary cortisol awakening response (CAR) (physiological). Randomized groups were not statistically different at baseline. Mixed models analysis of covariance (intent-to-treat) showed that intervention was associated with significantly lower caregiver stress 3 months post-transplant (Mean=20.0, CI95=17.9-22.0) compared to TAU (Mean=23.0, CI95=21.0-25.0) with an effect size (ES) of 0.39 (p=0.039). Secondary psychological outcomes, including depression and anxiety, were significantly reduced with ESs of 0.46 and 0.66 respectively. Caregiver CAR did not differ from non-caregiving controls at baseline and was unchanged by intervention. Despite significant caregiving burden, this psychosocial intervention significantly mitigated distress in Allo-HSCT caregivers.