背景:诊断为睾丸癌后立即出现困扰。历史上,由于复杂的因素,很难让人们参与护理模式来缓解痛苦,包括社会性别规范的不同应对策略和影响。现有的支持特别关注睾丸癌的长期幸存者,在诊断后不久,为患有痛苦的个体留下了对年龄和性别敏感的支持的未满足需求。
目的:我们评估了基于网络的干预措施,螺母和螺栓,旨在提供支持和缓解睾丸癌诊断后的痛苦。
方法:使用混合方法设计来评估可接受性,可行性,以及螺母和螺栓对遇险的影响,我们随机分配了最近诊断为睾丸癌(1:1)的参与者在同意时(早期)或替代地使用坚果和螺栓,1周后(第8天;延迟)。参与者在4至5周的时间内完成了系列问卷,以评估困扰水平(由国家综合癌症网络困扰温度计[DT]测量;得分0-10),焦虑,和抑郁(医院焦虑和抑郁评分[HADS]-焦虑和HADS-抑郁;每个评分0-21)。主要终点是同意和第8天之间的痛苦变化。次要的痛苦终点,焦虑,在随访期间以确定的时间间隔评估抑郁。可选,对完成定量评估后发生的半结构化访谈进行了主题分析。
结果:总体而言,39名参与者参加了这项研究。从睾丸切除术到研究同意的中位时间为14.8天(范围3-62天)。58%(23/39)的参与者在同意时报告了使用DT评估的中度或高度痛苦水平,并在观察1周后降低至13%(5/38)。与延迟干预相比,Nuts&Bolts的早期干预在第8天没有显着降低平均DT评分(早期:4.56-2.74,而延迟:4.47-2.74;P=.85),他们还无法访问该网站。较高的基线DT评分可显著预测在此期间DT评分的降低(P<.001)。中值DT,HADS-焦虑,和HADS-抑郁评分在睾丸切除术和术后3周之间降低,然后在整个观察期间保持稳定。对16次半结构化访谈的主题分析揭示了4个关键主题,“螺母和螺栓是一个有用的工具,\"\"使网站效益最大化,诊断和治疗准备的旋风,“和”主要的压力源和担忧,“以及多个子主题。
结论:诊断为睾丸癌后的困扰很常见;然而,它随着时间的推移而减少。螺母和螺栓被认为是有用的,可接受,与被诊断为睾丸癌的个体有关,大力支持半结构化访谈的主题分析所提供的干预。介绍支持的最佳时机,如螺母和螺栓,尚未确定;然而,一旦强烈怀疑或诊断出睾丸癌,这可能是最有益的。
BACKGROUND: Distress is common immediately after diagnosis of testicular cancer. It has historically been difficult to engage people in care models to alleviate distress because of complex factors, including differential coping strategies and influences of social gender norms. Existing support specifically focuses on long-term survivors of testicular cancer, leaving an unmet need for age-appropriate and sex-sensitized support for individuals with distress shortly after diagnosis.
OBJECTIVE: We evaluated a web-based intervention, Nuts & Bolts, designed to provide support and alleviate distress after diagnosis of testicular cancer.
METHODS: Using a mixed methods design to evaluate the acceptability, feasibility, and impact of Nuts & Bolts on distress, we randomly assigned participants with recently diagnosed testicular cancer (1:1) access to Nuts & Bolts at the time of consent (early) or alternatively, 1 week later (day 8; delayed). Participants completed serial questionnaires across a 4- to 5-week period to evaluate levels of distress (measured by the National Comprehensive Cancer Network Distress Thermometer [DT]; scored 0-10), anxiety, and depression (Hospital Anxiety and Depression Score [HADS]-Anxiety and HADS-Depression; each scored 0-21). The primary end point was change in distress between consent and day 8. Secondary end points of distress, anxiety, and depression were assessed at defined intervals during follow-up. Optional, semistructured interviews occurring after completion of quantitative assessments were thematically analyzed.
RESULTS: Overall, 39 participants were enrolled in this
study. The median time from orchidectomy to
study consent was 14.8 (range 3-62) days. Moderate or high levels of distress evaluated using DT were reported in 58% (23/39) of participants at consent and reduced to 13% (5/38) after 1 week of observation. Early intervention with Nuts & Bolts did not significantly decrease the mean DT score by day 8 compared with delayed intervention (early: 4.56-2.74 vs delayed: 4.47-2.74; P=.85), who did not yet have access to the website. A higher baseline DT score was significantly predictive of reduction in DT score during this period (P<.001). Median DT, HADS-Anxiety, and HADS-Depression scores reduced between orchidectomy and 3 weeks postoperatively and then remained stable throughout the observation period. Thematic analysis of 16 semistructured interviews revealed 4 key themes, \"Nuts & Bolts is a helpful tool,\" \"Maximizing benefits of the website,\" \"Whirlwind of diagnosis and readiness for treatment,\" and \"Primary stressors and worries,\" as well as multiple subthemes.
CONCLUSIONS: Distress is common following the diagnosis of testicular cancer; however, it decreases over time. Nuts & Bolts was considered useful, acceptable, and relevant by individuals diagnosed with testicular cancer, with strong support for the intervention rendered by thematic analyses of semistructured interviews. The best time to introduce support, such as Nuts & Bolts, is yet to be determined; however, it may be most beneficial as soon as testicular cancer is strongly suspected or diagnosed.