Rosland Ann-Marie, Piette John D
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, USA.
Chronic Illn. 2010 Mar;6(1):7-21. doi: 10.1177/1742395309352254.
We identify recent models for programmes aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified.
Structured review of studies published in medical and psychology databases from 1990 to the present, reference review, general Web searches and conversations with family intervention experts. Review was limited to studies on conditions that require ongoing self-management, such as diabetes, chronic heart disease and rheumatologic disease.
Programmes with three separate foci were identified: (1) Programmes that guide family members in setting goals for supporting patient self-care behaviours have led to improved implementation of family support roles, but have mixed success improving patient outcomes. (2) Programmes that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviours. (3) Programmes that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes.
The next generation of programmes to improve family support for chronic disease management incorporate a variety of strategies. Future research can define optimal clinical situations for family support programmes, the most effective combinations of support strategies, and how best to integrate family support programmes into comprehensive models of chronic disease care.
我们确定了旨在增强对成年患者慢性病管理和自我护理的有效家庭支持的近期项目模式，这些成年患者没有明显的身体或认知残疾。然后，我们总结了有关每种已确定模式疗效的证据。
对1990年至今在医学和心理学数据库中发表的研究进行结构化综述、参考文献综述、一般网络搜索，并与家庭干预专家进行交流。综述仅限于对需要持续自我管理的疾病的研究，如糖尿病、慢性心脏病和风湿性疾病。
确定了三个不同重点的项目：（1）指导家庭成员设定支持患者自我护理行为目标的项目，已使家庭支持角色的实施得到改善，但在改善患者结局方面成效不一。（2）对家庭进行支持性沟通技巧培训的项目，如促使患者采用应对技巧或使用自主性支持性陈述，已成功改善了患者的症状管理和健康行为。（3）正在开展为家庭提供协助监测临床症状和药物的工具及基础设施的项目，目前尚无证据表明其对患者结局的影响。
下一代改善家庭对慢性病管理支持的项目采用了多种策略。未来的研究可以确定家庭支持项目的最佳临床情况、支持策略的最有效组合，以及如何最好地将家庭支持项目纳入慢性病护理的综合模式。
