Multimodal psychosocial intervention for family caregivers of patients undergoing hematopoietic stem cell transplantation: A randomized clinical trial
Multimodal psychosocial intervention for family caregivers of patients undergoing hematopoietic stem cell transplantation: A randomized clinical trial
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DOI：
10.1002/cncr.32680
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发表时间：
2020-01-03
期刊：
影响因子：
6.2
通讯作者：
Temel, Jennifer S.
中科院分区：
文献类型：
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作者：
El-Jawahri, Areej;Jacobs, Jamie M.;Temel, Jennifer S.
背景：接受造血干细胞移植（HCT）患者的护理人员在HCT之前、期间和之后都承受着巨大的护理负担。方法：我们对马萨诸塞州总医院接受自体和异体HCT患者的护理人员进行了一项非盲、随机的心理社会干预（BMT-CARE）试验。护理人员被随机分配到BMT-CARE或常规护理组。BMT-CARE是根据HCT轨迹量身定制的，并将治疗相关教育和自我护理与认知行为技能相结合，以促进应对。分配到BMT-CARE的护理人员亲自、通过电话或通过视频会议与训练有素的干预专家（心理学家或社会工作者）会面，为期6次，从HCT前开始，一直持续到HCT后第60天。主要终点是可行性，定义为至少60%的符合条件的护理人员参加并完成50%或更多的干预疗程。我们在基线和HCT后30和60天评估了护理者的生活质量（QOL；护理者肿瘤生活质量问卷）、护理负担（护理者反应评估）、心理困扰（医院焦虑和抑郁量表）、自我效能（癌症自我效能量表-移植）和应对（现状测量）。我们使用混合线性效应模型来纵向评估BMT-CARE对结果的影响。结果：我们纳入了72.5%的符合条件的护理人员（138名中的100名），80%的人参加了50%或更多的干预会议。护理人员随机BMT-CARE报道提高生命质量(B = 6.11; 95%可信区间,3.50 - -8.71;P <措施),减少护理负担(B = -6.02; 95%可信区间,-8.49至-3.55;P <措施),降低焦虑(B = -2.18; 95%可信区间,-3.07至-1.28;P <措施)和抑郁症状(B = -1.23; 95%可信区间,-1.92至-0.54;P <措施),和提高自我效能感(B = 7.22; 95%可信区间,2.40 - -12.03;P = .003)和应对技能(B = 4.83; 95%可信区间,3.04 - -6.94;P <措施)与常规治疗组相比。结论针对HCT受者护理人员量身定制的短期多模式社会心理干预是可行的，可以改善患者的生活质量、情绪、应对和自我效能感，同时减轻患者急性期的护理负担。
BACKGROUND Caregivers of patients undergoing hematopoietic stem cell transplantation (HCT) experience an immense caregiving burden before, during, and after HCT. METHODS We conducted an unblinded, randomized trial of a psychosocial intervention (BMT-CARE) for caregivers of patients undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomly assigned to BMT-CARE or usual care. BMT-CARE was tailored to the HCT trajectory and integrated treatment-related education and self-care with cognitive-behavioral skills to promote coping. Caregivers assigned to BMT-CARE met with a trained interventionist (a psychologist or a social worker) in person, via telephone, or via videoconferencing for 6 sessions starting before HCT and continuing up to day +60 after HCT. The primary endpoint was feasibility, which was defined as at least 60% of eligible caregivers enrolling and completing 50% or more of the intervention sessions. We assesed caregiver quality of life (QOL; Caregiver Oncology Quality of Life Questionnaire), caregiving burden (Caregiver Reaction Assessment), psychological distress (Hospital Anxiety and Depression Scale), self-efficacy (Cancer Self-Efficacy Scale-Transplant), and coping (Measures of Current Status) at baseline and 30 and 60 days after HCT. We used mixed linear effect models to assess the effect of BMT-CARE on outcomes longitudinally. RESULTS We enrolled 72.5% of eligible caregivers (100 of 138), and 80% attended 50% or more of the intervention sessions. Caregivers randomized to BMT-CARE reported improved QOL (B = 6.11; 95% CI, 3.50-8.71; P < .001), reduced caregiving burden (B = -6.02; 95% CI, -8.49 to -3.55; P < .001), lower anxiety (B = -2.18; 95% CI, -3.07 to -1.28; P < .001) and depression symptoms (B = -1.23; 95% CI, -1.92 to -0.54; P < .001), and improved self-efficacy (B = 7.22; 95% CI, 2.40-12.03; P = .003) and coping skills (B = 4.83; 95% CI, 3.04-6.94; P < .001) in comparison with the usual-care group. CONCLUSIONS A brief multimodal psychosocial intervention tailored for caregivers of HCT recipients is feasible and may improve QOL, mood, coping, and self-efficacy while reducing the caregiving burden during the acute HCT period.