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Psico-oncologia : a influência de uma intervenção psicossocial na qualidade de vida e adaptação psicológica em doentes com cancro
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Objetivo: Avaliar a eficácia de uma adaptação transcultural da Psicoterapia de Grupo Centrada no Significado (PGCS) na melhoria da Qualidade de Vida (QdV), bem-estar espiritual e psicológico em doentes com cancro, e os processos terapêuticos de mudança promovidos pela psicoterapia. Métodos: Após a adaptação transcultural do manual standardizado da PGCS, foi realizada uma restruturação no número de sessões para garantir a viabilidade do estudo. Os participantes (n=91) com queixas psicológicas foram distribuídos, de acordo com a sua preferência, em 2 grupos: PGCS (n=51) e Care As Usual (n=40). Para a avaliação da eficácia, os outcomes primários foram a melhoria da QdV e bem-estar espiritual, e os secundários: redução da depressão, ansiedade e distress. Foram realizadas duas avaliações (intervalo de 1 mês) usando os seguintes instrumentos: Termómetro do Distress, McGill Quality of Life Questionnaire (MQOL), Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale (FACIT-Sp-12), e Hospital Anxiety and Depression Scale (HADS). Foram realizadas análises estatísticas quantitativa (tipos intent to treat [PGCS = 51 vs. CAU = 40] e, a posteriori, per protocol, com exclusão dos drop-outs [PGCS = 38 vs. CAU = 40]), nomeadamente ANCOVA para testar os efeitos de grupo, e mista para avaliação dos processos terapêuticos. Resultados: Foi verificado um efeito de grupo, de dimensões pequenas a elevadas, no qual o grupo da PGCS apresentou um aumento na QdV (b=0.81, p=.013, η2p=0.073), mas não no bem-estar espiritual, e um efeito de grupo, de dimensões pequenas a médias, com melhoria na depressão (b=-1.14, p=.044, η2p =0.048) e no distress (b=-1.38, p=.001, η2p=0.127); no que diz respeito ao bem-estar espiritual, comparando os valores da média da FACIT do grupo PGCS, antes e depois da intervenção, verificou-se que estavam acima da média do score total (os resultados foram suportados na análise per protocol). Constatou-se um efeito moderador da presença em ≥ 3 sessões na relação entre a o distress no início da psicoterapia e a QdV no final da intervenção, bem como o impacto das “Fontes Históricas do Significado” nos processos terapêuticos de mudança. Conclusões: Os resultados suportaram a eficácia da PGCS na QdV e no bem-estar psicológico, mas não para o bem-estar espiritual, embora, no último caso, o resultado necessite de ser contextualizado nos valores baseline da amostra.
Objective: To evaluate the efficacy of a transcultural adaptation of Meaning Centered Group Psychotherapy (MCGP) in improving Quality of Life (QoL), spiritual and psychological well-being in cancer patients, and the process of therapeutic changes promoted by the intervention. Methods: After the transcultural adaptation of the standardized MCGP manual, it was carried out a reformulation of the number of sessions to ensure the feasibility of the study. Participants (n=91) with psychological complaints were divided, according to their preference, into 2 groups: MCGP (n=51) and Care As Usual (n=40). Primary outcomes were QoL and spiritual well-being, and secondary were depression, anxiety and distress. It was performed 2 assessments (1 month interval) using the following instruments: Distress Thermometer, McGill Quality of Life Questionnaire (MQOL), Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale (FACIT-Sp-12), and Hospital Anxiety and Depression Scale (HADS). Quantitative (intent to treat [MCGP = 51 vs. CAU = 40] and, a posteriori, per protocol, excluding the drop-outs [MCGP = 38 vs. CAU = 40]), namely ANCOVA to test group effects, and mixed statistical analyses were carried out. Results: There was a group effect (small to high dimensions), in which MCGP group had an increase in QoL (b=0.81, p=.013, η2p = 0.073), but not in spiritual well-being, and a group effect (small to medium dimensions), with improvement in depression (b=-1.14, p=.044, η2p = 0.048) and distress (b=-1.38, p=.001, η2p = 0.127); in spiritual well-being, FACIT mean values of MCGP group, before and after the intervention, were above the average of the total score (these results were supported in the per protocol analysis). Presence in ≥ 3 sessions was a moderator in the relationship between distress at the beginning of psychotherapy and QoL at the end of the intervention, as well as the impact of the “Historical Sources of Meaning” in the therapeutic processes of change. Conclusions: This study supported the efficacy of MCGP in QoL and psychological well-being, but not for spiritual well-being (although these results need to be contextualized in the sample baseline values).
Objective: To evaluate the efficacy of a transcultural adaptation of Meaning Centered Group Psychotherapy (MCGP) in improving Quality of Life (QoL), spiritual and psychological well-being in cancer patients, and the process of therapeutic changes promoted by the intervention. Methods: After the transcultural adaptation of the standardized MCGP manual, it was carried out a reformulation of the number of sessions to ensure the feasibility of the study. Participants (n=91) with psychological complaints were divided, according to their preference, into 2 groups: MCGP (n=51) and Care As Usual (n=40). Primary outcomes were QoL and spiritual well-being, and secondary were depression, anxiety and distress. It was performed 2 assessments (1 month interval) using the following instruments: Distress Thermometer, McGill Quality of Life Questionnaire (MQOL), Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale (FACIT-Sp-12), and Hospital Anxiety and Depression Scale (HADS). Quantitative (intent to treat [MCGP = 51 vs. CAU = 40] and, a posteriori, per protocol, excluding the drop-outs [MCGP = 38 vs. CAU = 40]), namely ANCOVA to test group effects, and mixed statistical analyses were carried out. Results: There was a group effect (small to high dimensions), in which MCGP group had an increase in QoL (b=0.81, p=.013, η2p = 0.073), but not in spiritual well-being, and a group effect (small to medium dimensions), with improvement in depression (b=-1.14, p=.044, η2p = 0.048) and distress (b=-1.38, p=.001, η2p = 0.127); in spiritual well-being, FACIT mean values of MCGP group, before and after the intervention, were above the average of the total score (these results were supported in the per protocol analysis). Presence in ≥ 3 sessions was a moderator in the relationship between distress at the beginning of psychotherapy and QoL at the end of the intervention, as well as the impact of the “Historical Sources of Meaning” in the therapeutic processes of change. Conclusions: This study supported the efficacy of MCGP in QoL and psychological well-being, but not for spiritual well-being (although these results need to be contextualized in the sample baseline values).
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Palavras-chave
Psicoterapia de Grupo Centrada no Significado cancro adaptação transcultural eficácia qualidade de vida Meaning Centered Group Psychotherapy cancer transcultural adaptation efficacy quality of life