针对老年黑人手术患者的文化适应性围手术期心理健康干预措施

IF 4.4 2区 医学 Q1 GERIATRICS & GERONTOLOGY American Journal of Geriatric Psychiatry Pub Date : 2024-06-11 DOI:10.1016/j.jagp.2024.06.001
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引用次数: 0

摘要

目的老年黑人手术患者围手术期的心理健康与手术效果不佳有关;然而,目前还缺乏基于证据的围手术期干预措施。我们的两个研究目标包括:第一,研究影响有心理健康问题的老年黑人手术患者围手术期护理经验的因素;第二,确定适应文化的围手术期心理健康干预措施的设计和实施要求。设计环境和参与者我们与来自一家大型学术医疗中心的老年黑人患者(n = 15;≥50 岁;在过去 5 年内做过手术和/或对心理健康研究感兴趣;有应对手术/住院的痛苦、焦虑或抑郁史)进行了六次焦点小组讨论。我们邀请了研究合作伙伴,包括干预专家和社区成员,以收集关于干预和实施需求的见解。我们采用了归纳-演绎混合主题方法,使用开放式编码和美国国家少数民族健康和健康差异研究所研究框架。结果患者表示,在围手术期护理过程中,他们的心理健康和长期心理健康结果没有得到适当考虑。患者感知到的压力因素包括使用心理保健服务的人际障碍和结构性障碍、临床医生的治疗偏见和护理中的年龄歧视,以及缺乏医疗保健专业人员的联系/资源。患者使用了各种应对策略,包括谈话疗法、信仰/灵性以及家人和朋友。 结论:本研究为了解老年黑人手术患者的经历以及制定个性化围手术期心理健康干预措施的关键因素提供了宝贵的见解,以支持他们在手术前、手术中和手术后的身心健康。我们的研究结果表明,有必要针对个人/行为和人际关系层面采取以患者为中心、适应文化的干预措施。在文化适应框架的指导下,我们提出了一种整合了心理和药物成分的多成分干预措施。
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A Culturally Adapted Perioperative Mental Health Intervention for Older Black Surgical Patients

Objectives

Perioperative mental health of older Black surgical patients is associated with poor surgical outcomes; however, evidence-based perioperative interventions are lacking. Our two study objectives included: first, examine factors affecting perioperative care experiences of older Black surgical patients with mental health problems, and second, ascertain design and implementation requirements for a culturally-adapted perioperative mental health intervention.

Design Setting and Participants

We conducted six focus groups with older Black patients (n = 15; ≥50 years; surgery within the past 5 years and/or interest in mental health research; history of distress, anxiety, or depression coping with surgery/hospitalization/) from a large academic medical center. We engaged study partners, including interventionists and community members, to gather insights on intervention and implementation needs. We followed a hybrid inductive-deductive thematic approach using open coding and the National Institute on Minority Health and Health Disparities Research Framework.

Results

Patients reported that their psychological well-being and long-term mental health outcomes were not appropriately considered during perioperative care. Perceived stressors included interpersonal and structural barriers to using mental healthcare services, clinician treatment biases and ageism in care, and lack of healthcare professional connections/resources. Patients utilized various coping strategies, including talk therapy, faith/spirituality, and family and friends.

Conclusion

This study offers valuable insights into the experiences of older Black surgical patients and the critical elements for developing a personalized perioperative mental health intervention to support their well-being before, during, and after surgery. Our findings demonstrated a need for a patient-centered and culturally adapted intervention targeting the individual/behavioral and interpersonal levels. Informed by the cultural adaptation framework, we propose a multi-component intervention that integrates psychological and pharmacological components.
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来源期刊
CiteScore
13.00
自引率
4.20%
发文量
381
审稿时长
26 days
期刊介绍: The American Journal of Geriatric Psychiatry is the leading source of information in the rapidly evolving field of geriatric psychiatry. This esteemed journal features peer-reviewed articles covering topics such as the diagnosis and classification of psychiatric disorders in older adults, epidemiological and biological correlates of mental health in the elderly, and psychopharmacology and other somatic treatments. Published twelve times a year, the journal serves as an authoritative resource for professionals in the field.
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