Construction And Preliminary Application Of A Mindfulness Self-Compassion Intervention For Patients With Lung Cancer And Their Caregivers Based On The Theory Of Dyadic Illness Management

Objectives:The objectives were as follows.(1)To describe the current state of dyadic psychological stress responses in patients with lung cancer and their caregivers,to explore the role of mindfulness and self-compassion on dyadic psychological stress responses in patients with lung cancer and their caregivers,and to construct a model of dyadic psychological stress responses in patients with lung cancer and their caregivers;(2)Exploring the experience of dyadic adaptation to cancer in patients with lung cancer and their caregivers;(3)Constructing a dyadic mindfulness self-compassion intervention for patients with lung cancer and their caregivers;(4)To validate the feasibility and initial effectiveness of the dyadic mindfulness self-compassion intervention program for patients with lung cancer and their caregivers.Methods:This study consisted of the following four phases:(1)A study of the current state and role model of dyadic psychological stress responses in patients with lung cancer and their caregivers.A simple random sample(random number table method)was taken from January 2021 to June 2021 to select 254 pairs of patients with lung cancer and their caregivers who met the inclusion and exclusion criteria from the thoracic surgery,respiratory medicine,oncology,and radiotherapy departments of four tertiary hospitals in Hunan Province for a questionnaire survey.The survey indicators were selected based on the Dyadic Disease Management Theory and the constructed hypothetical model of dyadic psychological stress responses of patients with lung cancer and caregivers,including general demographic and clinical disease characteristics,disease perception(Disease Perception Questionnaire Simplified),mindfulness(Mindfulness Attention Awareness Scale),selfcompassion(Self-compassion Scale),dyadic coping(Dyadic Support Coping Scale),anxiety(7-item Generalized Anxiety Inventory),and depression(9-item Patient Health Questionnaire).Statistical analyses were conducted using SPSS 22.0 and AMOS 17.0,and structural equation modeling was used for construct an Actor-Partner Interdependence Model of dyadic psychological stress response process for patients with lung cancer and their caregivers.(2)A study on the experience of dyadic adaptation to cancer by patients with lung cancer and their caregivers.The interpretive phenomenological research method of qualitative research was used to explore the experiences of dyadic adaptation to cancer of patients with lung cancer and their caregivers.Using a purposive sampling method,patients with lung cancer and caregivers who met the inclusion and exclusion criteria were selected as study actors from July 2021 to August 2021 in the respiratory medicine and oncology departments of a tertiary hospital in Hunan Province.Twenty study actors were included in the final interviews,11 of whom were patients and 9 were caregivers,and patients with lung cancer and caregivers were invited to enter the conference room individually for a one-on-one semi-structured interview with the researcher.Colazzi’s phenomenological data analysis was used,coded and organized separately with the help of Nvivo 12.0 software,to deeply refine the themes of the experience of adaptation to cancer for patients with lung cancer and caregivers at all levels.(3)Construction of a mindfulness self-compassion intervention for patients with lung cancer and their caregivers based on the dualistic disease management theory.Based on the dyadic disease management theory,we integrated the results of the first part of the cross-sectional and second part of the qualitative study,combined with the positive selfcompassion training developed by Neff and Germer,and initially constructed a dyadic mindfulness self-compassion intervention for patients with lung cancer and their caregivers;and evaluated the preliminary version of the program using Delphi expert correspondence,and selected experts from medical oncology,oncology nursing,psychology,and nursing management.A total of 11 experts from medical oncology,oncology nursing,psychology,nursing management,etc.were selected.(4)Feasibility and preliminary effects of a dyadic mindfulness selfcompassion intervention for patients with lung cancer and their caregivers.Using a pilot design of a randomized controlled trial with a two-group design,the whole group was randomized to two oncology departments A and B from a tertiary hospital in Hunan Province with the same management model and the same type of patients admitted,and all patients with lung cancer and their caregivers from the two oncology departments were included in the study,and 17 pairs of patients with lung cancer and caregivers were finally recruited in each group.The study actors in the control group received a conventional care regimen,while those in the intervention group received a 6-week dyadic mindfulness self-compassion intervention in addition to conventional care,and patients and caregivers in both groups were followed up for 1 month.The anxiety,depression(primary outcomes),mindfulness,self-compassion,disease perception,dyadic coping,sense of disease benefit,and communication function(secondary outcomes)of patients with lung cancer and caregivers in both groups were evaluated before,immediately after,and 1 month after the intervention(T0,T1,and T2)in conjunction with surgery and chemotherapy for patients with lung cancer for followup surveys.Feasibility was assessed using recruitment rate,participation rate,adherence,retention rate,dropout rate,lost to follow-up rate,and occurrence of adverse events,and acceptability was assessed using a selfadministered satisfaction questionnaire and qualitative interviews.The quantitative part of the study was statistically analyzed with the help of SPSS 23.0 software,and generalized estimating equations were used to analyze the effects of the dyadic mindfulness self-compassion intervention on each outcome variable for patients with lung cancer and caregivers.Results:The results are summarized as follows according to four phases.(1)(i)The prevalence of depression and anxiety in patients with lung cancer was 21.3%(95%CI=16.2%to 26.3%)and 22.0%(95%CI=16.9%to 27.2%),respectively,and the prevalence of depression and anxiety in caregivers was 29.5%(95%CI=23.9%to 35.2%)and 33.5%(95%CI=27.6%～39.3%).(ii)Mindfulness and self-compassion of both patients with lung cancer and their caregivers negatively predicted their respective psychological stress response(anxiety and depression)scores.Hierarchical multiple regression analysis showed that depressed mood of patients with lung cancer was influenced by the number of comorbidities,number of hospitalizations,whether they had an informed cancer diagnosis,level of disease perception,level of mindfulness,and level of self-compassion;depressed mood of caregivers was influenced by the caregiver’s place of residence,number of people assisting in caregiving,level of disease perception,level of mindfulness,and level of selfcompassion;anxiety of patients with lung cancer was influenced by the duration of illness,time with family The anxiety of caregivers was influenced by the caregiver’s occupation,the type of relationship with the patient,the level of disease perception,the level of mindfulness,the level of self-compassion,and the level of dyadic coping.(ⅲ)Mediating effect analysis revealed a significant and partially mediated effect of the patient’s self-compassion in the actor mediation of their own illness perception and their own dyadic coping(B=-0.177,95%CI=-0.070 to0.292).The partner-mediated effect of caregiver’s self-compassion between the patient’s perception of illness and caregiver’s dyadic coping was significant and fully mediated(B=-0.117,95%CI=-0.220 to-0.028).Dyadic coping of both patients with lung cancer and caregivers negatively predicted their own depression(B=-0.025,P<0.01 and B=0.025,P<0.01)and anxiety(B=-0.025,P<0.01 and B=-0.024,P<0.01),i.e.,the actor effect held;but not each other’s depression(B=0.003,P=0.174 and B=0.009,P=0.555),and anxiety(B=0.001,P=0.793 and B=0.007,P=0.336),i.e.,the partner effect did not hold.(2)Seven themes of dyadic adaptation to the cancer experience of patients with lung cancer and their caregivers were analyzed through qualitative interviews:adaptation to serial life changes,generation of positive and negative emotional experiences,use of diverse communication patterns,revealing self-compassion behaviors,emergence of complex coping styles,adaptation gains,and adaptation challenges.(3)The effective rates of the two rounds of expert correspondence were 100.0%and 90.9%,and the rates of making suggestions were 100.0%and 70.0%,respectively;the authority coefficients of the experts were 0.92 and 0.91,respectively;the Kendall coefficients of the indicators at all levels were in the desirable range of 0.4 to 0.5,and the coefficients of variation were less than 0.25.The final version of the dyadic mindfulness self-compassion intervention for patients with lung cancer and their caregivers program,contained six sessions,12 intervention goals,and 32 intervention activities.(4)The results of the pretest were as follows:(ⅰ)Feasibility and acceptability assessment of the dyadic mindfulness self-compassion intervention:the overall course participation rate was 76.47%,the overall retention rate of the intervention program was 64.70%,and the overall satisfaction rates of patients and caregivers with the intervention program were 88.23%and 94.12%,respectively.Four themes were extracted from the qualitative assessment of acceptability:positive and negative evaluations of the intervention program emerged,multiple barriers to practicing the intervention program,suggestions to improve the intervention content,and encouragement of dyadic and group forms of intervention.(ⅱ)Preliminary effectiveness of the dyadic mindfulness selfcompassion intervention:generalized estimating equations were used to analyze the intervention effects of the dyadic mindfulness selfcompassion intervention on patients’ depression,anxiety,illness perception,mindfulness,and self-compassion,and the results showed that the main effect of grouping,the main effect of time,and the interaction between grouping and time were statistically significant(p<0.05);the intervention effects on patients’ dyadic coping,illness benefit perception,communication function showed no statistically significant effects for grouping and time(P>0.05);the intervention effects on caregivers’depression,mindfulness,and self-compassion showed statistically significant effects for grouping main effect,time main effect,and interaction between grouping and time(P<0.05);the intervention effects on caregivers’ anxiety,illness perception,dyadic coping,sense of illness benefit,and communication function showed no statistically significant interaction effects for grouping and time(P>0.05).Conclusions:The conclusions of the study were as follows.(1)(ⅰ)The situation of the psychological stress responses of patients with lung cancer and caregivers are relatively severe;(ⅱ)Mindfulness and self-compassion of both patients with lung cancer and their caregivers negatively predict their respective psychological stress response(anxiety and depression);the psychological stress responses of patients with lung cancer and caregivers are also influenced by sociodemographic factors,illness factors,caregiving factors,and psychological factors;(ⅲ)Self-compassion has an actor-partner-mediated interaction with illness perceptions between patients with lung cancer and caregivers.(3)Self-compassion has a actor-partner mediated reciprocal effect with illness perception and dyadic coping between patients with lung cancer and caregivers;no actor-partner mediated reciprocal effect was found on mindfulness,perception of illness and dyadic coping between patients with lung cancer and caregivers;only a actor effect exists between dyadic coping and anxiety and depression,and no partner effect exists.(2)Health-care providers should understand the emotional changes of the interactions between patients with lung cancer and caregivers,avoid the negative effects of negative emotions on both parties,exert the positive influence of positive emotions,promote the adaptation of the dichotomy to the impact of life changes,guide the dichotomy to use appropriate communication patterns and self-compassion behaviors,encourage the dichotomy to choose appropriate coping styles,and ultimately strengthen the gains of dyadic adaptation to illness and avoid the challenges of dyadic adaptation to illness.(3)The dyadic mindfulness self-compassion intervention includes six themes:establishing a group to live with cancer;practicing positive awareness;clarifying the dyadic relationship and introducing selfcompassion;promoting dyadic communication;promoting dyadic coping;and embracing the future.(4)The pilot mindfulness self-compassion intervention had good acceptability and general feasibility for patients with lung cancer and their caregivers,with positive effects on depression,mindfulness,and self-compassion for patients with lung cancer and caregivers;no significant effects on dyadic coping,sense of illness benefit,or communication function for both parties;and improved effects on anxiety and illness perception for patients,but no significant effects on anxiety and illness perception for caregivers.Pilot study may guide future largescale trials patients with lung cancer and caregivers in integrated care.