Does a Community-Based Stress Management Intervention Affect Psychological Adaptation Among Underserved Black Breast Cancer Survivors?
Does a Community-Based Stress Management Intervention Affect Psychological Adaptation Among Underserved Black Breast Cancer Survivors?
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DOI：
10.1093/jncimonographs/lgu032
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发表时间：
2014-11-01
期刊：
影响因子：
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通讯作者：
Antoni, Michael H.
中科院分区：
文献类型：
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作者：
Lechner, Suzanne C.;Whitehead, Nicole E.;Antoni, Michael H.
背景：在这项名为Project CARE的随机试验中，我们调查了参与认知-行为压力管理和乳腺癌健康与教育计划是否改善了未得到充分服务的黑人乳腺癌幸存者的心理结果。方法两种补充医学干预措施都是10个疗程，以小组为基础，从循证干预的角度适应社区黑人女性的文化。参与者是114名黑人女性(平均年龄51.1岁，27-77岁)，她们在登记前0-12个月完成乳腺癌治疗(0-IV期，平均癌症诊断时间=14.1个月)。女性在完成根治性治疗(即手术、化疗、放射肿瘤学)后，随机接受认知行为应激管理或癌症健康教育计划。结果从基线到6个月的随访期间，女性患者的保留率高达95%。两种情况下的参与者在干预后6个月的随访中都显示出心理健康指数的显著改善，包括总体生活质量(癌症治疗功能评估-乳房)、侵入性思维(事件影响量表-修订)、抑郁症状(流行病学研究中心-抑郁)和压力水平(感知压力量表)(所有重复测量对象内时间效应的方差分析：P<；0.05，除总体情绪外；情绪状态简介-简短版本)。然而，与假设相反，条件x时间效应在统计学上并不显著。结论研究结果表明，随着时间的推移，多项测量的改善可能是由于加强了压力管理方面的培训，广泛提供乳腺癌信息，或者参与了来自相似种族背景的持续支持小组。其影响涉及到关于适当的控制组的决定、在治疗过程中实施干预的时机、以及来自研究团队的感知支持。
Background In this randomized trial, Project CARE, we examined whether participation in a cognitive-behavioral stress management and breast cancer wellness and education program improved psychological outcomes among a sample of underserved black breast cancer survivors.Methods Both complementary medicine interventions were 10-sessions, manualized, group-based, and were culturally adapted for black women in the community from evidence-based interventions. Participants were 114 black women (mean age = 51.1, 27-77 years) who had completed breast cancer treatment 0-12 months before enrollment (stages 0-IV, mean time since cancer diagnosis = 14.1 months). Women were enrolled upon completion of curative treatment (ie, surgical, chemotherapy, radiation oncology) and randomized to receive cognitive-behavioral stress management or cancer wellness and education program.Results There was a remarkable 95% retention rate from baseline to 6-month follow-up. Participants in both conditions showed statistically significant improvement on indices of psychological well-being, including overall quality of life (Functional Assessment of Cancer Therapy-Breast), intrusive thoughts (Impact of Event Scale-Revised), depressive symptoms (Center for Epidemiologic Studies-Depression), and stress levels (Perceived Stress Scale) over the 6-month postintervention follow-up (all repeated measures analysis of variance within-subjects time effects: P < .05, except for overall mood; Profile of Mood States-Short Version). Contrary to hypotheses, however, condition x time effects were not statistically significant.Conclusions Findings suggest that improvements in multiple measures over time may have been due to intensive training in stress management, extensive provision of breast cancer information, or participation in an ongoing supportive group of individuals from a similar racial background. Implications bear on decisions about appropriate control groups, the timing of intervention delivery during the treatment trajectory, and perceived support from the research team.