正念癌症康复训练对癌症患者多维度健康的干预效果及机制研究

Background: Cancer remains an mportant public health problem worldwide. Following diagnosis and treatment, individuals experience persistent physical and psychological distress, consequently impacting their health and quality of life. Previous study has shown that Chinese cancer patients generally have poor psycho-social adaptation to the disease, with their supportive care needs largely unmet. The Mindfulness-based cancer recovery (MBCR) intervention is developed specifically for cancer patients, which is widely recognized for its proved efficacy in improving psycho-social and clinical outcome in western population. In our early work, we have culturally adapted the intervention for use in Chinese culture and piloted testing in cancer survivors. It is found that the adapted MBCR intervention is feasible and acceptable by Chinese cancer patients.. Objective: To adopt MBCR of the Canada version to Chinese culture and health care system, to examine the effectiveness of MBCR on physic-psycho-social health outcome and its underlying mechanisms. . Methods: This is a randomized clinical trial and in total 120 adult cancer patients will be recruited. Subject will be randomly assigned to either the experimental group or control group. All providers will be blinded to the study group assignment of the participants. The control group will be invited to participate in a one-day stress management training, with the experimental group receiving a 8-week MBCR program. The MBCR program cultivates mindfulness, awareness of the present moment in an open and nonjudgmental manner. . We will evaluate differences in multidimensional health and health economic outcomes in two groups at baseline, post- and 6 months after intervention and explore mediating effects of cognitive appraisal, coping, and social support variables on health outcome. . Significance: This proposed study is the first attempt to evaluate the effectiveness of culturally adapted MBCR on multidimensional health outcome in Chinese cancer patients. It will have great potentials in forming health policy report in guiding clinical practice.

癌症是人类面临的重要公共卫生问题之一。癌症的诊断和治疗给患者带来一系列身心压力，患者普遍存在心理社会适应性较差的问题，严重影响其生存质量和康复效果。正念癌症康复训练（MBCR)是一种针对癌症患者的心理社会干预项目，国外研究提示该项目能显著改善患者的心理社会适应状况及临床结局。本团队已对MBCR进行初步的调试，并在小样本癌症患者中进行测试，结果表明MBCR可行且易于被患者接受。本项目拟探讨调适后的MBCR项目对癌症患者生理-心理-社会多重健康指标的效果及作用机制。采用随机对照试验设计，对照组参加健康教育及1日的压力管理课程，实验组参加8周的MBCR干预。评价基线、干预结束、干预后6个月两组患者多维度健康指标的差别及相关卫生经济学指标，分析中介变量和调节变量对多维度健康指标的作用效果。本项目是国内首次系统评价MBCR项目对癌症患者的应用效果，有望形成卫生政策报告，具有推广应用前景。

正念癌症康复训练（MBCR）是一种针对癌症患者的心理社会干预项目，国外研究提示该项目能显著改善患者的心理社会适应状况及临床结局，但目前尚未应用在中国癌症患者人群。本项目探讨了调适后的MBCR项目对癌症患者生理-心理-社会多重健康指标的效果及作用机制。本项目包括两个阶段的研究，在第一阶段研究中，我们进行了在中国文化背景下的MBCR干预方案的调适； 第二阶段研究为调适后的MBCR干预的随机对照试验。在第二阶段的研究中，对照组参加健康教育及1日的压力管理课程，实验组参加4周的MBCR干预。比较了两组患者基线、干预结束、干预后6个月多维度健康指标及相关卫生经济学指标的差别，并分析MBCR的干预机制。.本项目重要结果：（1）在第一阶段研究中，采用Barrera修订后的启发式框架（Heuristic framework）作为方法学指导，根据其基于证据的五个调试步骤对已引入并汉化的MBCR干预方案进行规范化的文化调适，对MBCR的干预项目名称、干预时间、干预内容、干预形式进行修订，最终形成四周的MBCR干预方案。（2）第二阶段的随机对照试验仍在进行中。现有数据的结果显示，与对照组相比较，MBCR干预组的乳腺癌患者在焦虑抑郁情绪、睡眠质量、与疾病相关的症状方面均有所改善，正念觉知水平以及生活质量也得到提高。（3）参与者的质性访谈显示，MBCR能帮助她们更好的觉察情绪、提升情绪管理能力和在困境中保持内在稳定的能力。（4）以互联网为载体的线上干预形式具有较好的可行性，参与者的接受程度较高，在未来的研究中，可积极推动线上线下混合的干预形式。.本项目系首次将经过文化调适的MBCR干预应用到我国癌症患者人群，结果提示调适后的MBCR干预可以改善癌症患者人群的负性情绪、症状负担和生活质量等多重健康指标。在后期的研究中，我们将开展MBCR干预项目的临床转化和应用，在医院临床科室进行定期的MBCR干预的工作坊，对临床护理人员进行MBCR干预的培训，并对编制的《4周标准化MBCR干预手册》和辅助音频资料进行各种形式的交流和扩散。