A pragmatic randomized controlled pilot trial of brief meaning-centered psychotherapy in home care

IF 5.1 2区医学 Q1 ONCOLOGY

Cancer Pub Date : 2025-09-14 DOI:10.1002/cncr.70082

Rebecca M. Saracino PhD, Ellen Y. Park BA, Hayley Pessin PhD, Nicole Onorato MPH, Margaret V. McDonald MSW, Caraline Demirjian MPH, Elizabeth Schofield PhD, Barry Rosenfeld PhD, William Breitbart MD, Allison J. Applebaum PhD

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Abstract

Background

Individuals with advanced cancer receiving home health care experience elevated psychosocial and existential distress, yet few interventions address these concerns. This pilot randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of brief, nurse-delivered, meaning-centered psychotherapy in patients with advanced cancer compared with treatment as usual (TAU).

Methods

Distressed patients (aged 18 years and older) were randomized 1:1 to receive either a three-session Meaning-Centered Psychotherapy for Hospitals, Hospice, and Home (MCP-H; n = 33) or TAU (n = 32). Feasibility was based on recruitment, retention, data completion, fidelity, and intervention engagement. Acceptability was based on patients’ and nurses’ ratings of MCP-H satisfaction. Preliminary efficacy was determined by changes in scores from baseline (T1) to 6 weeks (T2) and 10 weeks (T3) in meaning, and secondary outcomes were assessed using between-group analysis.

Results

Seventy-one patients enrolled. Feasibility was demonstrated by satisfactory recruitment (75% approach-to-consent rate; 92% enroll-to-randomize rate), retention (74% and 75% at T2 and T3, respectively), intervention engagement (94% completed 100% of the sessions), and treatment adherence (87% mean rating). Participants endorsed the intervention’s acceptability (96% satisfied or very satisfied). MCP-H participants experienced improvements in meaning using the Cohen's d (d = 0.59 at T2; d = 0.39 at T3) and most other secondary psychosocial outcomes at 6 and 10 weeks compared with TAU participants.

Conclusions

MCP-H is feasible and acceptable among patients with advanced cancer in home care. This intervention demonstrated promising evidence of clinical efficacy. A larger, fully powered randomized controlled trial is needed to test the efficacy of the intervention for patients, nurses, and health system outcomes against an active control group.

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简短意义中心心理治疗在家庭护理中的实用随机对照试验

背景：接受家庭健康护理的晚期癌症患者会经历更高的社会心理和生存压力，但很少有干预措施解决这些问题。本随机对照试验考察了在晚期癌症患者中进行简短的、护士提供的、以意义为中心的心理治疗与常规治疗（TAU）的可行性、可接受性和初步疗效。方法将苦恼患者（18岁及以上）按1:1的比例随机分为三组，分别接受医院、临终关怀和家庭三阶段以意义为中心的心理治疗（MCP-H, n = 33）和TAU （n = 32）。可行性基于招募、保留、数据完成、保真度和干预参与。可接受性基于患者和护士对MCP-H满意度的评分。通过从基线（T1）到6周（T2）和10周（T3）的评分变化来确定初步疗效，并通过组间分析评估次要结局。结果纳入71例患者。可行性通过令人满意的招募（75%的接近同意率；92%的入组随机率）、保留（在T2和T3分别为74%和75%）、干预参与（94%完成100%的疗程）和治疗依从性（87%的平均评分）来证明。参与者认可干预的可接受性（96%满意或非常满意）。与TAU参与者相比，MCP-H参与者在第6周和第10周使用Cohen's d（在T2时d = 0.59；在T3时d = 0.39）和大多数其他次要社会心理结果的意义上都有改善。结论MCP-H在晚期癌症患者家庭护理中是可行和可接受的。这种干预显示出有希望的临床疗效。需要一个更大的、全动力的随机对照试验来测试干预对患者、护士和卫生系统结果的效果，而不是一个积极的对照组。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer 医学-肿瘤学

CiteScore

13.10

自引率

3.20%

发文量

480

审稿时长

2-3 weeks

期刊介绍： The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society. CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research