Harun Aisha, Harrison James D, Young Jane M
Surgical Outcomes Research Centre, Sydney Local Health Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Asia Pac J Clin Oncol. 2013 Jun;9(2):99-109. doi: 10.1111/j.1743-7563.2012.01531.x. Epub 2012 May 15.
Disparities in cancer outcomes for people from culturally and linguistically diverse (CALD) groups are well known. Improving CALD patients' active participation in treatment processes holds potential to improve outcomes, but little is known of effective strategies to facilitate this. This systematic review investigated interventions to improve three aspects of participation in cancer care among CALD groups, namely involvement in decision-making, communication with health providers and treatment adherence. A comprehensive search of electronic bibliographic databases was conducted to identify intervention studies that reported outcomes relevant to patient participation for CALD groups. Two reviewers independently critically appraised the studies and abstracted data. Of 10,278 potential articles, seven met the inclusion criteria, including three randomized controlled, three non-randomized and one mixed-method experimental studies. Interventions included the use of patient navigators, videos and decision aids. The impact on patient participation was varied. The effect of a decision aid and patient navigator interventions on communication with health providers was positive. While the use of a decisions aid successfully facilitated shared decision-making and patients' perception of treatment adherence, the use of patient navigators was ineffective. A computer support system was found to improve general patient participation; however little clarification of what this involved was provided. This systematic review identified few rigorous evaluations of interventions to improve treatment participation for CALD people with cancer, highlighting the lack of a robust evidence base to improve this crucial aspect of care. The development and evaluation of interventions for diverse populations remains a priority.
文化和语言背景多样（CALD）群体的癌症治疗结果存在差异，这是众所周知的。提高CALD患者在治疗过程中的积极参与度有可能改善治疗结果，但对于促进这一点的有效策略却知之甚少。本系统评价调查了旨在改善CALD群体参与癌症护理三个方面的干预措施，即参与决策、与医疗服务提供者沟通以及治疗依从性。对电子文献数据库进行了全面检索，以确定报告了与CALD群体患者参与相关结果的干预研究。两位评审员独立对研究进行严格评估并提取数据。在10278篇潜在文章中，有7篇符合纳入标准，包括3项随机对照试验、3项非随机试验和1项混合方法实验研究。干预措施包括使用患者导航员、视频和决策辅助工具。对患者参与的影响各不相同。决策辅助工具和患者导航员干预措施对与医疗服务提供者沟通的影响是积极的。虽然使用决策辅助工具成功促进了共同决策和患者对治疗依从性的认知，但使用患者导航员却无效。发现一种计算机支持系统可提高患者总体参与度；然而，对于这具体涉及哪些方面却几乎没有说明。本系统评价发现，针对改善CALD癌症患者治疗参与度的干预措施的严格评估很少，这凸显了在改善这一关键护理方面缺乏有力的证据基础。针对不同人群的干预措施的开发和评估仍然是一个优先事项。
