Howell Doris, Harth Tamara, Brown Judy, Bennett Cathy, Boyko Susan
University Health Network, Princess Margaret Cancer Center and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
Provincial Head Patient Education, Cancer Care Ontario, Toronto, ON, Canada.
Support Care Cancer. 2017 Apr;25(4):1323-1355. doi: 10.1007/s00520-016-3500-z. Epub 2017 Jan 5.
This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments.
Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include 'self-management patient education' or 'patient education'.
Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review.
Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.
本系统评价旨在确定自我管理教育干预措施的有效性以及关键组成部分,以帮助癌症患者培养有效自我管理疾病及治疗的急性或即时、长期和晚期有害影响所需的技能。
如果自我管理教育干预措施是随机对照试验(RCT),且包含研究团队列出的八个核心要素中的至少一个,则纳入研究。在Ovid MEDLINE(2005年至2015年4月)、Embase(2005年至2015年,第15周)、Cochrane系统评价数据库(2015年4月第4期)、CINAHL(2005年至2015年)和PsychINFO(2005年至2015年)中进行了系统检索。检索的关键词包括“自我管理患者教育”或“患者教育”。
共识别出42项针对癌症患者自我管理教育干预措施的随机对照试验。干预措施的异质性使得无法进行荟萃分析,但叙述性定性综合分析表明,自我管理教育干预措施可改善疲劳、疼痛、抑郁、焦虑、情绪困扰和生活质量等症状。核心要素特定组合的结果尚无定论。很少有研究使用相同的核心要素组合,即使在使用相同组合的研究中,结果也相互矛盾。因此,本评价无法评估与效果强度相关的自我管理教育干预措施的组成部分或要素。
明确癌症自我管理教育的核心组成部分以及支持有效自我管理所需纳入的基本要素,对于确保在癌症系统中持续有效地提供自我管理支持至关重要。