Zachariae Robert, O'Toole Mia S
Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark.
Psychooncology. 2015 Nov;24(11):1349-59. doi: 10.1002/pon.3802. Epub 2015 Apr 14.
This study aimed to evaluate the effectiveness of expressive writing intervention (EWI) for improving psychological and physical health in cancer patients and survivors.
We searched databases and existing reviews for randomized controlled studies published between 1986 and 2014 that evaluated the effects of EWI on psychological and physical health outcomes. We computed and combined effect sizes and examined the role of methodological characteristics.
From 223 unique citations, we identified 16 independent randomized controlled trials published from 1999 to 2014, examining the effect of EWI on a range of psychological and physical health outcomes. No statistically significant effects were found for any of the individual or combined psychological (Hedges's g: 0.04; 95% CI, -0.06 to 0.14; p = 0.42), physical (0.08; 95% CI, -0.05 to 0.20; p = 0.22), or quality-of-life outcomes (0.09; 95% CI, -0.05 to 0.24; p = 0.22). The results were unaffected by differences in study characteristics, for example, type of control condition, study setting, cancer type, and overall study quality ratings. Results from a subset of studies indicated a possible moderating effect of social constraints, suggesting that participants experiencing low levels of emotional support may be more likely to benefit from EWI.
Our results do not support the general effectiveness of EWI in cancer patients and survivors. However, given the practical and inexpensive intervention, it is possible that even small effects in subgroups of patients could be clinically relevant, and future studies are recommended to test the effects of potential moderators, including pre-intervention distress levels and context-dependent factors such as emotional support.
本研究旨在评估表达性写作干预（EWI）对改善癌症患者及幸存者心理和身体健康状况的有效性。
我们检索了数据库及现有综述，查找1986年至2014年间发表的评估EWI对心理和身体健康结局影响的随机对照研究。我们计算并合并效应量，同时考察方法学特征的作用。
从223条独特的文献引用中，我们识别出1999年至2014年间发表的16项独立随机对照试验，这些试验考察了EWI对一系列心理和身体健康结局的影响。在任何个体或合并的心理（赫奇斯g值：0.04；95%置信区间，-0.06至0.14；p = 0.42）、身体（0.08；95%置信区间，-0.05至0.20；p = 0.22）或生活质量结局（0.09；95%置信区间，-0.05至0.24；p = 0.22）方面均未发现统计学上的显著效应。研究结果不受研究特征差异的影响，例如对照条件类型、研究环境、癌症类型以及总体研究质量评分。部分研究结果表明社会限制可能存在调节效应，这表明情感支持水平较低的参与者可能更有可能从EWI中获益。
我们的结果不支持EWI对癌症患者及幸存者具有普遍有效性。然而，鉴于该干预措施实用且成本低廉，即使在患者亚组中有微小效应也可能具有临床意义，因此建议未来研究检验潜在调节因素的作用，包括干预前的痛苦水平以及诸如情感支持等情境相关因素。
