Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database.
Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database.
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DOI：
10.1002/cncr.33907
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发表时间：
2022-01-15
期刊：
影响因子：
6.2
通讯作者：
Bakitas, Marie A.
中科院分区：
文献类型：
--
作者：
Corn, Benjamin W.;Feldman, David B.;Hull, Jay G.;O'Rourke, Mark A.;Bakitas, Marie A.
希望，无论是固有的（“性格上的希望”）还是增强的（通过增强技术），都可能影响结果。我们着手确定诊断为晚期癌症患者的性格希望与生存的关系。我们重新分析了姑息治疗干预方案ENABLE的数据，以确定更高的性格希望与患者生存之间的关系。这是对ENABLE II和ENABLE III随机对照试验（rct）中有关性格希望和生存的数据进行的二次分析。从两份经过验证的基线问卷的三个“希望”项目中创建一个性格希望指数。在两项随机对照试验中收集处置希望和生存数据。在ENABLE II中，参与者被随机分配到ENABLE干预组或常规护理组。在ENABLE III中，参与者被随机分配在入组后立即或12周接受干预。529人被纳入Cox比例风险回归分析，以模拟性格希望对生存的影响。没有协变量的初步分析显示希望的显著影响（Wald = 8.649, HR = 0.941, CI: 0.904-0.980, p = 0.003），因此较高的性格希望与较长的生存期相关。在包含所有协变量的后续分析中，性格希望的影响接近统计学意义（Wald = 2.96, HR = 0.933, CI: 0.863-1.010, p = 0.085）。较高水平的性格希望与晚期癌症患者较长的生存期有关。需要前瞻性试验来确定性格和增强希望对晚期癌症患者预后的影响。在由随机试验汇集的信息组成的ENABLE数据库中，晚期癌症患者的性格希望与更长的生存期有关。因此，希望可能是临床试验设计中的一个重要分层参数，可以考虑为这些个体增加希望的研讨会。
Hopefulness, whether inherently present (“dispositional hope”) or augmented (by enhancement techniques) may impact outcomes. We set out to determine the association of dispositional hope with survival among patients diagnosed with advanced cancer. Data from ENABLE, a palliative care intervention, were re-analyzed to determine the association of higher dispositional hope and patient survival. This is a secondary analysis of data combined from the ENABLE II and ENABLE III randomized controlled trials (RCTs) relative to dispositional hope and survival. A dispositional hope index was created from three “hope” items from two validated baseline questionnaires. Dispositional hope and survival data were collected during the two RCTs. In ENABLE II, participants were randomly assigned to the ENABLE intervention or to usual care. In ENABLE III, participants were randomly assigned to receive the intervention immediately or 12 weeks after enrollment. 529 persons were included in Cox proportional-hazards regression analyses to model the effects of dispositional hope on survival. An initial analysis without covariates yielded a significant effect of hope, (Wald = 8.649, HR = 0.941, CI: 0.904–0.980, p = 0.003), such that higher dipositional hope was associated with longer survival. In a subsequent analysis that included all covariates, the effect of dispotional hope approached statistical significance (Wald = 2.96, HR = 0.933, CI: 0.863–1.010, p = 0.085). Higher levels of dispositional hope was associated with longer survival in patients with advanced cancer. Prospective trials are needed to determine the effects of dispositional and augmented hope on outcomes of patients with advanced cancer. Within the ENABLE database, composed of information pooled from randomized trials, dispositional hope was associated with longer survival among patients with advanced cancer. Accordingly, hope may be an important stratification parameter in the design of clinical trials and workshops to augment hopefulness might be considered for such individuals.
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