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(Cost-)Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Cancer Patients (BeMind)

18. september 2017 opdateret af: Radboud University Medical Center

(Cost-) Effectiveness of Mindfulness Based Cognitive Therapy (MBCT) in Cancer Patients: a Superiority Trial of Online and Face-to-face Treatment Versus Treatment as Usual (TAU).

Mindfulness-based cognitive therapy has been demonstrated to be effective in reducing anxiety, depression and fatigue in cancer patients. As this intervention can be offered in groups, costs are relatively low. In addition, delivering MBCT online might make the intervention more accessible and cost-effectiveness. However, more information is needed about what treatment works best for which patient.

Therefore, the aim of this study is to investigate clinical and cost-effectiveness of both individual MBCT online and MBCT offered as a group training compared to TAU .

Study design: The design of the study will be a multi-centre, randomised, superiority trial, comparing MBCT online and MBCT offered as a group training with TAU. Participants in the TAU condition will be randomised to one of the treatment conditions after 3 months. Main assessments will take place at baseline (T0), post-treatment (T1), and 3 (T2) and 9 months after post-treatment (T3).

We expect the MBCT conditions to be superior to TAU in terms of improving mindfulness skills, anxiety and depressive compants, psychological well-being, rumination and fear of cancer recurrence. We also expect the MBCT to result in patients returning to work earlier, have a higher work ability and have lower medical care costs, thereby being more cost-effective than TAU.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

245

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Holland
    • Gelderland
      • Nijmegen, Gelderland, Holland, 6500HB
        • Radboud University Medical Centre for Mindfulness, Radboud University Nijmegen Medical Centre
    • Utrecht
      • Bilthoven, Utrecht, Holland, 3723 MB
        • Helen Dowling Institute

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • HADS ≥ 11
  • Cancer diagnosis (at present or past)
  • Stable dose if using psychopharmacological medication for at least 3 months
  • computer literacy and acces to internet
  • capable of filling out questionnaires in Dutch

Exclusion Criteria:

  • severe psychiatric morbidity as psychoses, suicidal ideation
  • previous mindfulness-based treatment.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Enkelt gruppeopgave
  • Maskning: Enkelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Online MBCT
Adfærdsmæssigt: Mindfulness Based Cognitive Therapy
This MBCT protocol consists of 8 weekly sessions of 2,5 hours each and a silent day of 6 hours of meditation practice. Similar to group MBCT, in the online MBCT group, participants will be asked to practice at home for 45 minutes, 6 days a week. They will receive files with meditation and yoga exercises to support this.
Eksperimentel: group MBCT
Adfærdsmæssigt: Mindfulness Based Cognitive Therapy
This MBCT protocol consists of 8 weekly sessions of 2,5 hours each and a silent day of 6 hours of meditation practice. Similar to group MBCT, in the online MBCT group, participants will be asked to practice at home for 45 minutes, 6 days a week. They will receive files with meditation and yoga exercises to support this.
Ingen indgriben: Treatment as usual
3 months waiting list, subsequent assignment to group or online MBCT

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change from baseline in anxiety and depressive symptoms
Tidsramme: 0 (baseline), 3 months (post intervention)
Anxiety and depressive symptoms as assessed by the Hospital Anxiety and Depression-scale (HADS). The HADS is a self-report questionnaire that comprises 14 items measuring feelings of generalized fear and depressive symptoms. The HADS is considered a reliable and valid instrument for assessing anxiety and depression in medical patients and is sensitive to change (Herrmann, 1997; Bjelland et al., 2002). This instrument was also validated in a palliative cancer population (Akechi, 2006).
0 (baseline), 3 months (post intervention)

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change from baseline in fear of cancer recurrence
Tidsramme: 0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
Fear of cancer recurrence will be assessed with the Fear of Cancer Recurrence Inventory (FCRI; Simard & Savard, 2009a; van der Lee et al., 2012).
0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
DSM-IV Axis I mood or anxiety disorders
Tidsramme: 0, 3 (post intervention), 12 months (9mo follow-up)
DSM IV Axis I psychiatric disorder as diagnosed by a structured interview
0, 3 (post intervention), 12 months (9mo follow-up)
Change from baseline in positive mental health
Tidsramme: 0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
The Mental Health Continuum-Short Form (MHC-SF) measures positive mental health and comprises 14 items, representing various feelings of well-being. Respondents rate the frequency of every feeling in the past month on a 6-point Likert scale (never, once or twice a month, about once a week, two or three times a week, almost every day, every day). The MHC-SF contains three subscales: emotional, psychological and social well-being. MHC-SF has shown high internal and moderate test-retest reliability, convergent and discriminant validity.
0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
Change from baseline in healthcare consumption
Tidsramme: 0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
The TIC-P generates quantitative data about direct medical costs and indirect societal costs as a consequence of psychological/psychiatric illnesses.
0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
Change from baseline in health-related quality of life
Tidsramme: 0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
To measure the quality of the health status of cancer patients a validated health-related quality of life (HRQoL) instrument will be used, the EuroQol-5D (EQ-5D). This HRQoL instrument will be completed by the patient together with a researcher and is available in a validated Dutch translation (Lamers, 2005). The EQ-5D is a generic HRQoL instrument comprising five domains: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The EQ-5D index is obtained by applying predetermined weights to the five domains. This index gives a societal-based global quantification of the participant's health status on a scale ranging from 0 (death) to 1 (perfect health). Participants will also be asked to rate their overall HRQoL on a visual analogue scale (EQ- 5D VAS) consisting of a vertical line ranging from 0 (worst imaginable health status) to 100 (best imaginable).
0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
Change from baseline in health-related quality of life
Tidsramme: 0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
In addition to the EQ-5D, the SF-12 will be administered for explorative purposes for there are indications that the SF-12 is more sensitive for changes in HRQol in populations with less severe morbidity (Johnson and Coons, 1998).
0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
Change from baseline in mindfulness skills
Tidsramme: 0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
The 39-item Five Facet Mindfulness Questionnaire has been developed as a reliable and valid comprehensive instrument for assessing different aspects of mindfulness. A Dutch 24-item short form of the FFMQ (FFMQ-SF) was developed and assessed in a sample of 376 adults with clinically relevant symptoms of depression and anxiety and cross-validated in an independent sample of patients with fibromyalgia. Confirmatory factor analyses showed good model fit for the five-factor structure of the FFMQ-SF: observing, describing, acting with awareness, nonjudging, and nonreactivity. The FFMQ-SF was related to measures of psychological symptoms, well-being, experiential avoidance, and the personality factors neuroticism and openness to experience.
0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
Change from baseline in rumination
Tidsramme: 0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
The rumination subscale of the RRQ assesses a neurotic self-attentiveness (i.e. recurrent, primarily past-oriented thinking about the self), which is prompted by threats, losses, of injustices to the self. Subjects rate their level of agreement of disagreement on a five-point rating scale (e.g., "I always seem to be rehashing in my mind recent things I've said or done"). There is evidence of good internal consistency (.90) and stability over a 10-month period and convergent validity. The measure in the current study was translated into Dutch using the guidelines of the International Test Commission (Hambleton, 1994). Cronbach's alphas were .88 and .90 in Sample 1, and .90 and .91 in Sample 2, respectively (Luyckx et al., 2008).
0, 3 (post intervention), 6 (3mo follow-up) and 12 months (9mo follow-up)
Change from baseline in personality assessment
Tidsramme: 0 (baseline) and 12 months (9mo follow-up)
Personality is measured with the NEO Five Factor Inventory (NEO-FFI, Costa & McCrae, 1992) which consists of five domains: neuroticism, extraversion, openness, altruism, and conscientiousness.
0 (baseline) and 12 months (9mo follow-up)
Change in mindfulness skills during intervention
Tidsramme: week 2,3,4,5,6,7,8 and 9 of intervention
The Mindful Attention Awareness Scale (MAAS) will be administered before each MBCT session to assess mindful attention in daily life
week 2,3,4,5,6,7,8 and 9 of intervention
Group cohesion during intervention
Tidsramme: week 4 and week 9 during intervention
We will examine self-reported individual group cohesion ratings during the MBCT training with a Dutch Group Cohesion Questionnaire that has been used in cancer patients before (May et al., 2008). The GCQ-23 uses 22 items across four scales: the bond with the group as whole, the bond with other members, cooperation within the group and the instrumental value. Each item is rated from 1 (totally disagree) to 6 (totally agree). Internal consistency of all scales was reported to range from adequate to good (0.66-0.88).
week 4 and week 9 during intervention
Working alliance during intervention
Tidsramme: week 4 and week 9 during intervention
The Working Alliance Inventory (WAI) is most often used to assess working alliance between participant and healthcare professional. We will use the Dutch translation of the short form (WAI-S, Vervaeke & Vertommen, 1996), which is closely related to the original scale and also has good psychometric and predictive quality (Busseri & Tyler, 2003). The WAI-S is a 12 item, self report questionnaire, rated on a 7-point Likert scale (1 = never to 7 = always) with three subscales: 1) agreement between participant and therapist on the goals of the therapy; 2) agreement on the rationale of the therapy addressing the problems of the participant; and 3) the quality of the interpersonal bond between the participant and the therapist.
week 4 and week 9 during intervention
Change in mood during intervention
Tidsramme: week 2,3,4,5,6,7,8 and 9 of intervention
In the current study, positive and negative affect is assessed before each MBCT session using the International Positive and Negative Affect Scale - Short Form. The cross-sample stability, internal reliability, temporal stability, crosscultural factorial invariance, and convergent and criterion-related validities of the I-PANAS-SF were examined and found to be psychometrically acceptable (Thompson, 2007).
week 2,3,4,5,6,7,8 and 9 of intervention
Change from baseline in anxiety and depressive symptoms - follow up
Tidsramme: 0, (baseline) 6 (3mo follow-up) and 12 months (9mo follow-up)
Hospital Anxiety and Depression Scale - anxiety and depressive symptoms at follow up.
0, (baseline) 6 (3mo follow-up) and 12 months (9mo follow-up)

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Radboud University Medical Center

Efterforskere

  • Ledende efterforsker: Anne EM Speckens, MD, PhD, Radboud University Medical Centre Nijmegen

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Hjælpsomme links

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. april 2014

Primær færdiggørelse (Faktiske)

20. juli 2016

Studieafslutning (Faktiske)

1. maj 2017

Datoer for studieregistrering

Først indsendt

6. maj 2014

Først indsendt, der opfyldte QC-kriterier

12. maj 2014

Først opslået (Skøn)

14. maj 2014

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

19. september 2017

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

18. september 2017

Sidst verificeret

1. februar 2016

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 2012.WO14.C153
  • NL46338.091.13 (Registry Identifier: Toetsingonline)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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