Govender Roganie, Smith Christina H, Taylor Stuart A, Barratt Helen, Gardner Benjamin
University College London, Health Behaviour Research Centre & University College London Hospital, Head & Neck Cancer Centre, Ground Floor Central, 250 Euston Road, London, NW1 2PQ, UK.
Division of Psychology & Language Sciences University College London, London, UK.
BMC Cancer. 2017 Jan 10;17(1):43. doi: 10.1186/s12885-016-2990-x.
Dysphagia is a significant side-effect following treatment for head and neck cancers, yet poor adherence to swallowing exercises is frequently reported in intervention studies. Behaviour change techniques (BCTs) can be used to improve adherence, but no review to date has described the techniques or indicated which may be more associated with improved swallowing outcomes.
A systematic review was conducted to identify behavioural strategies in swallowing interventions, and to explore any relationships between these strategies and intervention effects. Randomised and quasi-randomised studies of head and neck cancer patients were included. Behavioural interventions to improve swallowing were eligible provided a valid measure of swallowing function was reported. A validated and comprehensive list of 93 discrete BCTs was used to code interventions. Analysis was conducted via a structured synthesis approach.
Fifteen studies (8 randomised) were included, and 20 different BCTs were each identified in at least one intervention. The BCTs identified in almost all interventions were: instruction on how to perform the behavior, setting behavioural goals and action planning. The BCTs that occurred more frequently in effective interventions, were: practical social support, behavioural practice, self-monitoring of behaviour and credible source for example a skilled clinician delivering the intervention. The presence of identical BCTs in comparator groups may diminish effects.
Swallowing interventions feature multiple components that may potentially impact outcomes. This review maps the behavioural components of reported interventions and provides a method to consistently describe these components going forward. Future work may seek to test the most effective BCTs, to inform optimisation of swallowing interventions.
吞咽困难是头颈癌治疗后的一个重要副作用，但在干预研究中经常报告吞咽练习的依从性较差。行为改变技术（BCTs）可用于提高依从性，但迄今为止尚无综述描述这些技术，也未指出哪些技术可能与改善吞咽结果更相关。
进行了一项系统综述，以确定吞咽干预中的行为策略，并探讨这些策略与干预效果之间的关系。纳入了对头颈癌患者的随机和半随机研究。只要报告了有效的吞咽功能测量方法，改善吞咽的行为干预即为合格。使用经过验证的93种离散BCTs的综合列表对干预措施进行编码。通过结构化综合方法进行分析。
纳入了15项研究（8项随机研究），在至少一项干预措施中分别确定了20种不同的BCTs。几乎在所有干预措施中都确定的BCTs是：关于如何执行该行为的指导、设定行为目标和行动计划。在有效干预措施中更频繁出现的BCTs是：实际的社会支持、行为练习、行为自我监测以及可信来源，例如提供干预措施的熟练临床医生。对照组中相同BCTs的存在可能会削弱效果。
吞咽干预具有多个可能影响结果的组成部分。本综述梳理了已报告干预措施的行为组成部分，并提供了一种方法来持续描述这些组成部分。未来的工作可能会寻求测试最有效的BCTs，为优化吞咽干预提供依据。
