背景:接受造血细胞移植(HCT)的青少年(AYAs)处于心理社会健康状况差的高风险中。这项研究旨在确定促进压力管理(PRISM)干预措施是否在移植后的前6个月内减轻了这些风险。
方法:这种多站点,平行,随机试验于2019年4月至2023年3月进行.符合条件的AYAs年龄在12-24岁之间,说英语,并在1个月内HCT为癌症或癌症易感性综合征。他们被分配给PRISM1:1(简短的,基于技能的干预目标定位“韧性资源”[压力管理,目标设定,认知重构,和意义制作])或常规护理(UC)。结果包括抑郁和焦虑的总症状(医院焦虑和抑郁量表;主要结果),希望(斯奈德希望量表),韧性(10项康纳-戴维森韧性量表),和健康相关的生活质量(HRQOL;儿科生活质量清单癌症模块)。利用多变量线性回归分析;探索性分析评估基线抑郁或焦虑的影响。
结果:在94个注册和随机分配的AYAs中,平均年龄为16.7岁(SD,4.2);43(46%)为女性,56(60%)是非西班牙裔白人,22(23%)是西班牙裔,9人(10%)是黑人。大多数(77%)患有白血病。在随机分配给PRISM的n=50和UC的n=44中,37例(74%)和33例(73%)完成了所有研究程序,分别。在意向治疗分析中,PRISM不影响6个月的抑郁和焦虑(β=-1.1;95%CI,-3.7至1.5),希望(β=0.83;95%CI,-3.3至4.9),恢复力(β=-0.01;95%CI,-3.0至3.0),或HRQOL(β=1.5;95%CI,-4.7至7.9)。在预先存在焦虑或抑郁的AYAs中,PRISM收件人报告说,希望在6个月内有更大的改善(分数变化,+3.71;SD,6.9)与UC收件人(分数变化,-2.76;SD,6.5)(p=.04)。
结论:弹性训练不影响本样本的结果。探索性发现表明,当针对并发困扰的人时,它可能会更有效。
BACKGROUND: Adolescents and young adults (AYAs) receiving hematopoietic cell transplantation (HCT) are at high risk of poor psychosocial health. This study aimed to determine whether the Promoting Resilience in Stress Management (PRISM) intervention mitigated these risks during the first 6 months posttransplant.
METHODS: This multisite, parallel, randomized trial was conducted from April 2019 to March 2023. Eligible AYAs were aged 12-24 years, English speaking, and within 1 month of HCT for cancer or cancer predisposition syndrome. They were assigned 1:1 to PRISM (a brief, skills-based intervention targeting \"resilience resources\" [stress management, goal setting, cognitive reframing, and meaning making]) or usual care (UC). Outcomes included total symptoms of depression and anxiety (Hospital Anxiety and Depression Scale; primary outcome), hope (Snyder Hope Scale), resilience (10-item Connor-Davidson Resilience Scale), and health-related quality of life (HRQOL; Pediatric Quality of Life Inventory Cancer Module). Analyses leveraged multivariable linear regressions; exploratory analyses assessed the influence of baseline depression or anxiety.
RESULTS: Of 94 enrolled and randomized AYAs, the mean age was 16.7 years (SD, 4.2); 43 (46%) were female, 56 (60%) were non-Hispanic White, 22 (23%) were Hispanic, and nine (10%) were Black. Most (77%) had leukemia. Of n = 50 randomized to PRISM and n = 44 to UC, 37 (74%) and 33 (73%) completed all study procedures, respectively. In intention-to-treat analyses, PRISM did not affect 6-month depression and anxiety (β = -1.1; 95% CI, -3.7 to 1.5), hope (β = 0.83; 95% CI, -3.3 to 4.9), resilience (β = -0.01; 95% CI, -3.0 to 3.0), or HRQOL (β = 1.5; 95% CI, -4.7 to 7.9). Among AYAs with preexisting anxiety or depression, PRISM recipients reported greater 6-month improvements in hope (score change, +3.71; SD, 6.9) versus UC recipients (score change, -2.76; SD, 6.5) (p = .04).
CONCLUSIONS: Resilience coaching did not influence outcomes in this sample. Exploratory findings suggest it may be more effective when directed toward those with concurrent distress.