Mindfulness and Skills Based Distress Reduction in Oncology: Das Webbasierte Psychoonkologische Make It Training

Zusammenfassung

Eine bedürfnisorientierte psychoonkologische Unterstützung für Frauen, die an Brustkrebs erkrankt sind, ist v. a. in strukturschwachen Gebieten nicht genügend vorhanden. Moderne telemedizinische und webbasierte Angebote (eHealth) können einen wichtigen Mehrwert in der psychoonkologischen Versorgung darstellen, da sie im Rahmen des Selbstmanagements unabhängig von personellen Ressourcen, Zeit und Ort verfügbar sind. Bisher fehlen solche supportive psychoonkologische Angebote weitestgehend im deutschsprachigen Raum. Aus diesem Grund wurde ein psychoonkologisches Online-Programm entwickelt. Inhalte für die zeitgemäße webbasierte, bedürfnisorientierte, psychoonkologische Intervention wurden aus Literatur und eigenen Vorstudien entwickelt. Ein Manual für ein Skills- und Achtsamkeitstraining (Make It Training- Mindfulness and skills based distress reduction training in oncology) im Websetting wurde entworfen, programmiert und elektronisch umgesetzt. Diese Intervention beinhaltet insgesamt acht krankheitsbezogene Sitzungen mit Lehrvideos, Audiodateien, interaktiven Arbeitsblättern, persönlicher Skillsbox sowie daraus entstehendem Abschlussmaterial nach jeder Sitzung. Die hier vorgestellten Bausteine zur Psychoedukation und Vermittlung von verhaltenstherapeutischen Skills zu den Themen Emotionsmanagement, Ressourcen, Stressmanagement und Selbstzuwendung, sowie ein fortlaufendes Achtsamkeitsmodul wurden entwickelt. Eine Akzeptanzüberprüfung (N=35) ergab hohe Werte für Akzeptanz und Zufriedenheit seitens der Patientinnen. 87% der Patientinnen würden anderen betroffenen Frauen das Make It Training weiterempfehlen. Mit dem Make It Training steht ein Programm zur Verfügung, das effektive Bewältigungsstrategien und Fertigkeiten im Umgang mit psychischen Belastungen und Anforderungen, die durch eine Krebserkrankung entstehen, vermittelt. Das webbasierte psychoonkologische Selbstmanagementprogramm kann die Versorgung in einem gestuften Ansatz nicht zuletzt in strukturschwachen Regionen für Patienten mit onkologischen Erkrankungen verbessern.

Abstract

In rural areas, breast cancer-affected patients still do not receive sufficient psycho-oncological care that addresses their specific needs. As a partial solution, telemedicine and web-based applications (eHealth) can add value to their psycho-oncological care as part of self-management regardless of personnel resources, geographical distance from providers, and time constraints. Thus far, however, those supportive aspects of psycho-oncological care are lacking in German-speaking rural areas. For this reason a web-based intervention was developed. Based on the results of a representative cross-sectional and the current literature, we developed a manual and program called Make It Training (Mindfulness and skills based distress reduction in oncology) which was programmed for the websetting. The interactive web-based intervention with 8 sessions integrates different media, including tutorial videos, audio, personal skills box and individual exercises to enhance knowledge about specific disease-related themes. The intervention derives from mindfulness and conveys psychoeducational elements and cognitive behavioural skills with the themes of emotion management, resources, stress management, and self-compassion. The acceptance testing (N=35) showed considerable acceptance and satisfaction. 87% of the patients would recommend the Make it Training to other patient. Prospectively, this training could convey effective strategies for coping with disease-related burden. The Make It Training is an innovative self-management program that can be used for the stepped-care approach and be implemented in rural areas and thereby enhance current outpatient care.

Schlüsselwörter

Psychoonkologie - eHealth - kognitive Verhaltenstherapie - Achtsamkeit - Selbstmanagement

Key words

psycho-oncology - eHealth - self-management program - cognitive behavioural therapy - mindfulness

• Literatur

• 1 Hennigs A, Riedel F, Gondos A. et al. Prognosis of breast cancer molecular subtypes in routine clinical care: A large prospective cohort study. BMC Cancer 2016; 16: 734. doi:10.1186/s12885-016-2766-3
• 2 Walker J, Hansen CH, Martin P. et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry 2014; 1: 343-350. doi:10.1016/S2215-0366(14)70313-X
• 3 Cordova MJ, Riba MB, Spiegel D. Post-traumatic stress disorder and cancer. Lancet Psychiatry 2017; DOI: 10.1016/S2215-0366(17)30014-7.
• 4 Mehnert A, Brähler E, Faller H. et al. Four-Week Prevalence of Mental Disorders in Patients With Cancer Across Major Tumor Entities. J Clin Oncol 2014; DOI: 10.1200/jco.2014.56.0086..
• 5 Vehling S, Koch U, Ladehoff N. et al. Prävalenz affektiver und angststörungen bei krebs: systematischer literaturreview und metaanalyse. Psychother Psych Med 2012; 62: 249-258. doi:10.1055/s-0032-1309032
• 6 Kuhnt S, Brähler E, Faller H. et al. Twelve-month and lifetime prevalence of mental disorders in cancer patients. Psychother Psychosom 2016; 85: 289-296. doi:10.1159/000446991
• 7 Li M, Kennedy EB, Byrne N. et al. Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer. Psycho-Oncology 2016; doi: DOI: 10.1002/pon.4286.
• 8 Casellas-Grau A, Font A, Vives J. Positive psychology interventions in breast cancer. A systematic review. Psycho-Oncology 2014; 23: 9-19. doi:10.1002/pon.3353
• 9 Carey M, Lambert S, Smits R. et al. The unfulfilled promise: a systematic review of interventions to reduce the unmet supportive care needs of cancer patients. Supportive Care in Cancer 2012; 20: 207-219. doi:10.1007/s00520-011-1327-1
• 10 Faller H, Schuler M, Richard M. et al. Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol 2013; 31: 782-793. doi:10.1200/JCO.2011.40.8922
• 11 Hartmann M, Haun MW, Sklenarova H. et al. Psychoonkologische Versorgung in Stadt und LandPsycho-oncological care in rural and urban areas. Onkologe. 2017; 23: 742-749. doi:10.1055/s-0030-1262442
• 12 Ernst J, Zenger M, Schmidt R. et al. Versorgung und psychosozialer Betreuungsbedarf von Krebspatienten im Stadt-Land-Vergleich – eine Literaturübersicht. Dtsch Med Wochenschr 2010; 135: 1531-1537. doi:10.1055/s-0030-1262442
• 13 Dilworth S, Higgins I, Parker V. et al. Patient and health professionalʼs perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review. Psycho-Oncology 2014; 23: 601-612. doi:10.1002/pon.3474
• 14 Zebrack BJ, Block R, Hayes-Lattin B. et al. Psychosocial service use and unmet need among recently diagnosed adolescent and young adult cancer patients. Cancer 2013; 119: 201-214. doi:10.1002/cncr.27713
• 15 Ryhänen AM, Siekkinen M, Rankinen S. et al. The effects of Internet or interactive computer-based patient education in the field of breast cancer: a systematic literature review. Patient Educ Couns 2010; 79: 5-13. doi:10.1016/j.pec.2009.08.005
• 16 McAlpine H, Joubert L, Martin-Sanchez F. et al. A systematic review of types and efficacy of online interventions for cancer patients. Patient Educ Couns 2014; DOI: 10.1016/j.pec.2014.11.002..
• 17 Leykin Y, Thekdi SM, Shumay DM. et al. Internet interventions for improving psychological well-being in psycho-oncology: review and recommendations. Psycho-Oncology 2012; 21: 1016-1025. doi:10.1002/pon.1993
• 18 Baker TB, Hawkins R, Pingree S. et al. Optimizing eHealth breast cancer interventions: which types of eHealth services are effective?. Transl Behav Med 2011; 1: 134-145. doi:10.1007/s13142-010-0004-0
• 19 Hong Y, Pena-Purcell NC, Ory MG. Outcomes of online support and resources for cancer survivors: a systematic literature review. Patient Educ Couns 2012; 86: 288-296. doi:10.1016/j.pec.2011.06.014
• 20 Lange L, Schulz H, Bleich C. E-Health-Angebote in der Onkologie. Onkologe 2018; 24: 406-410. doi:10.1007/s00761-018-0348-5
• 21 Urech C, Grossert A, Alder J. et al. Web-Based Stress Management for Newly Diagnosed Patients With Cancer (STREAM): A Randomized, Wait-List Controlled Intervention Study. J Clin Oncol 2018; 36: 780. doi:10.1200/JCO.2017.74.8491
• 22 van den Berg SW, Gielissen MF, Custers JA. et al. BREATH: web-based self-management for psychological adjustment after primary breast cancer – results of a multicenter randomized controlled trial. 2015; 33: 2763-2771. doi:10.1200/JCO.2013.54.9386.
• 23 Ruland CM, Andersen T, Jeneson A. et al. Effects of an internet support system to assist cancer patients in reducing symptom distress: a randomized controlled trial. Cancer Nurs 2013; 36: 6-17. doi:10.1097/NCC.0b013e31824d90d4
• 24 Ebert DD, Lehr D, Baumeister H. et al. GET. ON Mood Enhancer: efficacy of Internet-based guided self-help compared to psychoeducation for depression: an investigator-blinded randomised controlled trial. Trials 2014; 15: 39. doi:10.1186/1745-6215-15-39
• 25 Reins JA, Ebert DD, Lehr D. et al. Internet-based treatment of major depression for patients on a waiting list for inpatient psychotherapy: protocol for a multi-centre randomised controlled trial. BMC Psychiatry 2013; 13: 318. doi:10.1186/1471-244X-13-318
• 26 Salzer MS, Palmer SC, Kaplan K. et al. A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancer. Psycho-Oncology 2010; 19: 441-446. doi:10.1002/pon.1586
• 27 Bouma G, Admiraal JM, de Vries EG. et al. Internet-based support programs to alleviate psychosocial and physical symptoms in cancer patients: A literature analysis. Crit Rev Oncol Hematol 2015; 95: 26-37. doi:10.1016/j.critrevonc.2015.01.011.
• 28 Ringwald J, Marwedel L, Junne F. et al. Demands and Needs for Psycho-Oncological eHealth Interventions in Women With Cancer: Cross-Sectional Study. JMIR Cancer 2017; 3: e19. doi:10.2196/cancer.7973
• 29 Ahmad S, Fergus K, McCarthy M. Psychosocial issues experienced by young women with breast cancer: the minority group with the majority of need. Curr Opin Support Palliat Care 2015; 9: 271-278. doi:10.1097/SPC.0000000000000162
• 30 Taylor S, Harley C, Absolom K. et al. Breast Cancer, Sexuality, and Intimacy: Addressing the Unmet Need. Breast J 2016; 22: 478-479 doi:10.1111/tbj.12614
• 31 Zainal NZ, Booth S, Huppert FA. The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: A meta-analysis. Psycho-Oncology 2013; 22: 1457-1465. doi:10.1002/pon.3171
• 32 Boyle CC, Stanton AL, Ganz PA. et al. Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol 2017; 85: 397. doi:10.1037/ccp0000186
• 33 Rush SE, Sharma M. Mindfulness-based stress reduction as a stress management intervention for cancer care: a systematic review. J Evid Based Complementary Altern Med 2017; 22: 348-360. doi:10.1177/2156587216661467
• 34 van de Wal M, Thewes B, Gielissen M. et al. Efficacy of blended cognitive behavior therapy for high fear of recurrence in breast, prostate, and colorectal cancer survivors: the SWORD study, a randomized controlled trial. J Clin Oncol 2017; 35: 2173-2183. doi:10.1200/JCO.2016.70.5301