背景

牢固的家庭纽带似乎可以缓解患者和家人在生活和健康危机中的艰难经历。家庭参与式尊严治疗计划是以患者家庭为中心的心理干预，是基于尊严治疗制定，由一名治疗师根据特定的问题提示以访谈的形式进行。

目标

这项研究旨在确认家庭参与式尊严治疗计划在改善血液系统恶性肿瘤患者及其家庭护理人员的心理健康、家庭凝聚力和适应性方面的功效。

设计

单盲，双臂平行组随机对照试验。

场所

参加者为2019年3月至9月从福建医科大学附属协和医院招募的患者家庭照顾者二元组。

方法

共有68个合格的二元组同意参加，并随机分配到干预组（n = 33）或接受常规护理的对照组（n = 35）。干预组中的每对患者家庭二元组接受一个治疗师根据特定问题提示进行的两到三次访谈（每次访谈大约持续45至60分钟），其中包含针对患者的10个问题和针对其家庭护理人员的10个相应问题。为了评估干预措施的效果，我们在基线（T0）、1周时（ T1）、干预后4周（T2）和干预后8周（T3）评估了患者的希望，精神健康，家庭凝聚力和适应能力，以及他们的家庭护理人员的抑郁，焦虑、家庭凝聚力和适应能力，并比较两组之间的得分。

结果

对于患者而言，干预组和对照组之间的希望（p = 0.001），精神健康（p = 0.002），家庭凝聚力（p <0.001）和适应性（p <0.001）存在显著差异。家庭凝聚力（p = 0.018）和适应性（p = 0.003）在随时间的变化在上也很显著。希望（p = 0.034），精神健康（p <0.001），家庭凝聚力（p <0.001）和适应性（p <0.001）的交互作用具有显著意义。对于家庭照顾者而言，干预组和对照组之间的焦虑（p = 0.037），抑郁（p = 0.001）和家庭适应性（p = 0.036）存在显著差异。在组内，家庭适应性有显著差异（p = 0.012）。此外，焦虑（p = 0.001）和家庭凝聚力（p = 0.038）的交互作用具有显著意义。

结论

家庭参与式尊严治疗计划对促进患者的希望，精神健康以及家庭凝聚力和适应性发挥了积极作用；在家庭照顾者中，它减少了焦虑和抑郁，并增强了家庭凝聚力和适应能力。

注册编号：ChiCTR1900021433

Background

Strong family ties appear to buffer patient's and family members’ difficult experiences during life and health crises. The family participatory dignity therapy programme, a patient-family-centred psychological intervention, was developed based on dignity therapy and performed by one therapist in the form of interview according to a specific question prompt.

Objectives

This study aimed to confirm the efficacy of the family participatory dignity therapy programme in improving the psychological well-being and family cohesion and adaptability of patients with hematologic malignancies and their family caregivers.

Design

A single-blinded, two-arm parallel group, randomised controlled trial was conducted.

Setting(s)

and Participants: Participants were patient-family caregiver dyads recruited from Fujian Medical University Union Hospital from March to September 2019.

Methods

A total of 68 eligible dyads agreed to participate and were randomly assigned to the intervention group (n=33) or control group receiving usual care (n=35). Each pair of patient-family dyads in the intervention group received two or three interviews (each interview approximately lasting 45 to 60 minutes) performed by one therapist according to a specific question prompt containing 10 questions for patients and 10 corresponding questions for their family caregivers. To evaluate the effects of the intervention, we assessed patients’ hope, spiritual well-being, and family cohesion and adaptability, as well as their family caregivers’ depression, anxiety, and family cohesion and adaptability at baseline (T0), 1 week (T1), 4 weeks (T2), and 8 weeks post-intervention (T3) and compared the scores between the groups. A two-way repeated-measures analysis of variance was conducted to examine the effects of time, group, and their interaction.

Results

For patients, there was a significant difference in hope (p=0.001), spiritual well-being (p=0.002), and family cohesion (p<0.001) and adaptability (p<0.001) between the intervention and control groups. The difference over time was also significant in family cohesion (p=0.018) and adaptability (p=0.003). The interaction effects were significant for hope (p=0.034), spiritual well-being (p<0.001), and family cohesion (p<0.001) and adaptability (p<0.001). For family caregivers, there was a significant difference in anxiety (p=0.037), depression (p=0.001), and family adaptability (p=0.036) between the intervention and control groups. Within groups, a significant difference in family adaptability (p=0.012) was found. Moreover, the interaction effects were significant on anxiety (p=0.001) and family cohesion (p=0.038).

Conclusions

The family participatory dignity therapy programme showed a positive effect on promoting patients’ hope, spiritual well-being, and family cohesion and adaptability; among family caregivers, it decreased anxiety and depression, and enhanced family cohesion and adaptability.

Registration number: ChiCTR1900021433

原文链接：

https://www.sciencedirect.com/science/article/pii/S0020748921000626