Nurse practitioner-delivered cognitive-behavioral treatment as a novel implementation route for irritable bowel syndrome: A proof of concept.
Nurse practitioner-delivered cognitive-behavioral treatment as a novel implementation route for irritable bowel syndrome: A proof of concept.
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执业护士提供的认知行为治疗作为肠易激综合征的一种新颖的实施途径：概念证明。
DOI：
10.1111/nmo.14526
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发表时间：
2023
影响因子：
3.5
通讯作者：
Kuo,Braden
中科院分区：
文献类型：
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作者：
BurtonMurray,Helen;Weeks,Imani;Thurler,Andrea;Calabrese,Samantha;KateLapinel,Mary;Madva,ElizabethN;Staller,Kyle;Keefer,Laurie;Kuo,Braden
背景：基于暴露的认知行为疗法（暴露- CBT）对肠易激综合征（IBS）有效。然而，由于缺乏经过脑-肠行为治疗培训的行为健康提供者，很少有患者接受暴露- CBT。护士从业人员（NPs）可以满足可扩展的交付方法的关键需求。在一项针对罗马IV定义的IBS成人患者的5期NP -交付暴露- CBT的实用调查中，我们评估了治疗的可行性和可接受性，并探讨了临床结果的变化。方法：采用暴露- CBT作为常规护理的一部分，包括每隔一周进行4次治疗和2个月的强化治疗。患者可选择性地参加观察性研究，包括治疗前、治疗中、治疗后调查和治疗后定性访谈。根据录音完成NP治疗方案依从性和能力评分的独立编码评分，评分范围为1（完全没有）到5（完全）。结果25例患者同意（年龄22 - 67岁，76%为女性，48%为IBS -腹泻为主）。可行性高，依从性平均= 4.1，NP能力平均= 4.8,72%的治疗完成，93%的满意度评分≥3。治疗满意度高（4/4“非常满意”（n= 9）， 3/4“非常满意”（n= 5））。在IBS症状严重程度（- 53%;Hedge'sg= 1.0； 95%可信区间[CI] = 0.5, 1.5）和IBS生活质量（+31%;Hedge'sg= 0.8; 95% CI = 0.4, 1.2）方面，治疗对临床结果有很大改善。结论：snp暴露- CBT治疗IBS最初是可行的，并且具有良好的临床改善前景。研究结果将为未来的NIH 1B期/ORBIT IIB期试点随机对照试验提供信息。
BackgroundExposure‐based cognitive–behavioral therapy (exposure‐CBT) is efficacious for irritable bowel syndrome (IBS). However, few patients receive exposure‐CBT due to a lack of behavioral health providers trained in brain–gut behavior therapies. Nurse practitioners (NPs) could fill a critical need for scalable delivery methods. In a pragmatic investigation of a 5‐session NP‐delivered exposure‐CBT for adults with Rome IV‐defined IBS, we evaluated treatment feasibility and acceptability and explored changes clinical outcomes.MethodsExposure‐CBT was delivered as part of routine care involving four sessions every other week and a 2‐month booster session. Patients could electively participate in an observational study including pre‐, mid‐, and post‐treatment surveys and a post‐treatment qualitative interview. Independently coded ratings of NP treatment protocol adherence and competence ratings were completed from audio recordings, rated on a 1 (not at all) to 5 (completely) scale.ResultsTwenty‐five patients consented (ages 22‐67 years; 76% female; 48% IBS‐diarrhea predominant). There was high feasibility—adherence average = 4.1, NP competence average = 4.8, 72% treatment completion, 93% satisfaction scores ≥3. Treatment satisfaction was high (rated as 4/4 “very satisfied” byn= 9 and as 3/4 “mostly satisfied” byn= 5). There were improvements in clinical outcomes across treatment with large effects for IBS‐symptom severity (−53%; Hedge'sg= 1.0; 95% confidence interval [CI] = 0.5, 1.5) and IBS quality of life (+31%; Hedge'sg= 0.8; 95% CI = 0.4, 1.2).ConclusionsNP‐delivered exposure‐CBT for IBS was initially feasible and acceptable with promising clinical improvements. Findings will inform a future NIH Stage 1B/ORBIT Phase IIB pilot randomized control trial.