护士主导的支持表达小组干预对乳腺癌幸存者创伤后成长的影响

2022
01/14

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NursingResearch护理研究前
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自我表露的四个主题可以帮助患者在创伤后成长,这种方法可以作为乳腺癌患者住院期间的心理支持技术

Abstract

Background

Post-traumatic growth induced from cancerdiagnosis and treatment could benefit the prognosis of cancer survivors, butintervention based on self-disclosure in group is limited.

Objective

Aimed to examine the effectiveness of a supportive-expressivegroup intervention on post-traumatic growth. The impact of the intervention onanxiety and depression were also explored.

Design

This randomized clinical trial enrolledpatients from June 2017 to September 2018 with a one-month follow-up. Datacollectors were blinded to patient grouping.

Setting

A single center study in Chengdu, China.

Participants

One hundred sixty-eight participants whomet the eligibility criteria were randomly assigned to the intervention group (n = 84)or control group (n = 84); 46 were excluded and 122 patientsfinished the one-month follow-up.

Methods

Participants in the intervention groupreceived nurse-led support intervention focusing on topics such as “Being aPatient”, “Interpersonal Relationships”, “Journey for Recovery”, and “Planningthe Future” while participants in the control group received health education,rehabilitation training etc. according to the nursing routine of breast cancerpatients. The intervention was designed in accordance with the diagnosis andtreatment process as well as patient needs. Participants in both groups wereevaluated three times (T1-baseline before the intervention, T2-end of theintervention, and T3-1 month follow up). Post-traumatic growth, anxietyand depression were evaluated.

Results

Participants in the intervention groupreported higher level of post-traumatic growth (p < 0.01 or0.05) and reduced anxiety and depression (p < 0.01 or 0.05and p < 0.01 or 0.05). The multilevel model indicated thatthe intervention significantly promoted post-traumatic growth (βT3 = 7.87,p < 0.05) and dimensions of relating to others (βT3 = 4.26,p < 0.001), personal strength (βT3 = 4.27,p < 0.01), appreciation of life (βT3 = 8.69,p < 0.001), and new possibilities (βT3 = 1.91,p < 0.05), anxiety (βT3 = −3.63,p < 0.001), and depression (βT3 = −2.27,p < 0.001), but had no effect on the dimension of spiritualchange. In addition, the multi-level model showed that patients with youngerages (β = −0.05~−0.52, p < 0.05–0.001),with high school and above education levels (β = 1.53~9.29, p < 0.01)and accompanied by husbands(β = −1.48~−8.51, p < 0.05)had more effective intervention and patients with religious belief had a betterspiritual change level (β = 1.86, p < 0.001).

Conclusions

These findings provide evidence for thepotential effectiveness of the nurse-led intervention on positive benefits ofpost-traumatic growth and relieved anxiety and depression for Chinese breastcancer survivors and will inform the design and development of a largerandomized controlled trial.

Clinical relevance

The supportive-expression groupintervention can be applied independently by nurses. The four themes ofself-disclosure can help patients grow after trauma, and this method can beused as a psychological support technique for breast cancer patients duringhospitalization.

摘要翻译(仅供参考)

背景

癌症诊断和治疗引起的创伤后成长可能有益于癌症幸存者的预后,但基于群体自我表露的干预是有限的。

客观的

旨在检查支持-表达团体干预对创伤后成长的有效性。还探讨了干预对焦虑和抑郁的影响。

设计

这项随机临床试验招募了 2017 年 6 月至 2018 年 9 月的患者,并进行了为期一个月的随访。数据收集者对患者分组不知情。

环境

在中国成都进行的单中心研究。

参与者

168名符合资格标准的参与者被随机分配到干预组(n  =84)或对照组(n  =84);46 例被排除,122 例患者完成了 1 个月的随访。

方法

干预组的参与者接受护士主导的支持干预,重点关注“做一个病人”、“人际关系”、“康复之旅”和“规划未来”等主题,而对照组参与者接受健康教育、康复根据乳腺癌患者的护理程序进行培训等。干预是根据诊断和治疗过程以及患者的需求设计的。两组参与者均接受 3 次评估(干预前的 T1 基线、干预结束的 T2 和 T3-1 个月的随访)。评估了创伤后成长、焦虑和抑郁。

结果

干预组的参与者报告了更高水平的创伤后成长(p  < 0.01 或 0.05)以及减少的焦虑和抑郁(p  < 0.01 或 0.05 和p  < 0.01 或 0.05)。多层次模型表明,干预显着促进了创伤后成长(β T3  = 7.87,p  < 0.05)和与他人相关的维度(β T3  = 4.26,p  < 0.001),个人力量(β T3  = 4.27,p  < 0.01)、对生活的欣赏 ( β T3  = 8.69, p  <0.001) 和新的可能性 ( β T3 = 1.91, p  <0.05)、焦虑 ( β T3  = -3.63, p  <0.001) 和抑郁 ( β T3  = -2.27, p  <0.001),但对灵性改变的维度没有影响。此外,多水平模型显示,患者年龄较小(β  =-0.05~-0.52,p  <0.05-0.001),高中及以上文化程度(β  =1.53~9.29,p  <0.01)并伴有丈夫(β  = -1.48~-8.51,p  < 0.05)干预更有效,有宗教信仰的患者有更好的精神变化水平(β  = 1.86,p  < 0.001)。

结论

这些发现为护士主导的干预对中国乳腺癌幸存者的创伤后成长和缓解焦虑和抑郁的积极益处的潜在有效性提供了证据,并将为大型随机对照试验的设计和开发提供信息。

临床相关性

支持表达小组干预可由护士独立应用。自我表露的四个主题可以帮助患者在创伤后成长,这种方法可以作为乳腺癌患者住院期间的心理支持技术。


THE   END

  

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关键词:
growth,乳腺癌,幸存者,护士,创伤,干预,小组,影响,抑郁,焦虑

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