A Longitudinal Study of Phased Psychological Intervention on Psychological Adjustment in Cancer Patients During ICU Stay and Recovery

Summary

This protocol aims to longitudinally track and improve cancer ICU patients' psychological adaptation by evaluating staged, personalized intervention's impact on anxiety, depression, resilience, post-traumatic stress disorder (PTSD), and quality of life.

Abstract

This protocol presents a longitudinal study designed to evaluate a phased psychological intervention for cancer patients during, and after intensive care unit (ICU) stay. The intervention is structured in three stages: (1) acute-phase cognitive-behavioral therapy (CBT) during ICU hospitalization, (2) transitional-phase meaning-centered Managing Cancer And Living Meaningfully (CALM) therapy post-discharge, and (3) long-term family support and community linkage. A total of 120 cancer ICU patients will be allocated to either the staged intervention group, or standard care. Psychological adjustment outcomes-including anxiety, depression, post-traumatic stress disorder (PTSD), resilience, and quality of life-will be assessed longitudinally from baseline to 24 months post-discharge. The study aims to provide a structured, evidence-based psychological care pathway for ICU cancer patients, with potential implications for integrated psycho-oncology care models.

Introduction

The intensive care unit (ICU) environment, essential for treating critically ill patients, presents significant psychological challenges that can impede recovery. For cancer patients, these challenges are compounded by the inherent stress of their diagnosis and treatment, leading to complex psychological crises such as anxiety, depression, and post-traumatic stress disorder (PTSD), which often persist long after discharge^1,2,3. While the importance of psychological support in critical care is increasingly recognized, significant gaps remain in understanding the dynamic psycho....

Protocol

1. Ethics and consent

1. Submit the complete study protocol to the Ethics Committee of the Henan Vocational College of Nursing for review.
2. Ensure the study receives formal approval (Approval Number: 20141124) prior to initiation of any procedures.
3. Present a detailed written informed consent form to each potential participant prior to any study-related activities.
4. For patients lacking decision-making capacity, present the consent form to their legally authorized representative or guardian.

2. Participant selection and group allocation

1. Cohort identific....

Results

Comparison of baseline information

The final analytic sample comprised 120 critically ill cancer patients, randomly distributed between the experimental and control conditions, with 60 participants in each treatment arm. Comparison of the baseline characteristics between the two groups showed that the patients' psychological status presented clinically significant abnormalities, and the HADS scores of the patients in both groups exceeded the clinical threshold (HADS-A > 11 .......

Discussion

This study implemented a phased, multidisciplinary psychological intervention protocol for cancer patients during and after ICU stay, demonstrating significant long-term improvements across multiple psychosocial outcomes compared to standard care.

The intervention's success relied on several key protocol-driven steps. First, the initial psychological stratification using HADS and PCL-C at ICU admission enabled timely, tailored targeting of predominant anxiety, depression, or PTSD symptoms .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
CALM Therapy Manual	Managing Cancer And Living Meaningfully (CALM) Program Developers	Adapted from Rodin et al. (2018)	Structured therapy manual adapted for post-discharge phase, focusing on four domains: symptom management, self-concept/relationships, meaning/purpose, and future planning/hope.
Connor-Davidson Resilience Scale (CD-RISC-10)	Connor & Davidson	10-Item Abridged Version	10-item unidimensional self-report scale measuring psychological resilience.
European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30)	EORTC Quality of Life Group	Version 3.0 (Chinese Version)	30-item cancer-specific health-related quality of life questionnaire. Contains functional, symptom, and global health/QoL scales.
Family APGAR Scale	Smilkstein, G.	N/A (Public Domain Instrument)	5-item questionnaire assessing patient satisfaction with family support across five domains: Adaptation, Partnership, Growth, Affection, and Resolve.
Hospital Anxiety and Depression Scale (HADS)	Zigmond & Snaith	N/A	14-item self-report questionnaire for screening anxiety (HADS-A) and depression (HADS-D) in non-psychiatric hospital settings.
Mini-Mental State Examination (MMSE)	Folstein, M.F. et al.	Chinese Version	30-point questionnaire used to screen for cognitive impairment.
Post-Traumatic Stress Disorder Checklist – Civilian Version (PCL-C)	Weathers, F.W. et al. / National Center for PTSD	N/A	17-item self-report measure assessing PTSD symptom severity based on DSM-IV criteria.
Statistical Analysis Software	IBM SPSS	Version 26.0	Used for all statistical analyses, including descriptive statistics, t-tests, chi-square tests, and ANOVA.
Visual Analog Scale (VAS) Ruler	Generic Medical Supplier	N/A	Used for pain assessment (0-10 scale).