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[心理教育干预对癌症幸存者的影响:系统评价与荟萃分析]

[Effects of Psychoeducational Intervention for Cancer Survivors: A Systematic Review and Meta-Analysis].

作者信息

Park Jin Hee, Bae Sun Hyoung

机构信息

College of Nursing · Nursing Research Institute, Ajou University, Suwon, Korea.

出版信息

J Korean Acad Nurs. 2017 Apr;47(2):143-163. doi: 10.4040/jkan.2017.47.2.143.

Abstract

PURPOSE

This study was a systematic review and meta-analysis designed to investigate effects of psychoeducational intervention for cancer survivors.

METHODS

Ten databases were searched. Two reviewers independently performed the selection of the studies, data extraction and assessment. The risk of bias was assessed using Cochrane Collaboration's tool. To estimate the effect size, meta-analysis of the studies was performed using Comprehensive Meta-Analysis and RevMan programs.

RESULTS

Of 18,781 publications identified, 35 met inclusion criteria, and 25 studies were used to estimate effect size of psychoeducational intervention. Effect sizes (standardized mean difference [SMD]) were heterogeneous and random effects models were used in the analyses. Psychoeducational intervention was effective for quality of life (n=2,410, ES=0.23; 95% CI: 0.090.37), coping and self-efficacy (n=179, ES=0.68; 95% CI: 0.261.11), anxiety (n=1,786, ES=-0.26; 95% CI: -0.37-0.15), depression (n=1,910, ES=-0.28; 95% CI: -0.37-0.18), and psychological distress (n=2,242, ES=-0.31; 95% CI: -0.46~-0.17). Subgroup analysis showed that counseling was the most effective intervention for quality of life, and behavioral therapy was an effective intervention for all positive and negative outcomes. Publication bias was not detected except for psychological distress.

CONCLUSION

Psychoeducational intervention appears to be effective in improving quality of life and coping and self-efficacy, and it is effective in reducing psychological symptoms in cancer survivors. Behavioral therapy, especially, is commonly effective in improving psychosocial outcomes. However, low-quality evidence, variability in the designs of existing studies, and publication bias suggest that additional high-quality trials should be conducted in the future.

摘要

目的

本研究是一项系统评价和荟萃分析,旨在调查心理教育干预对癌症幸存者的影响。

方法

检索了十个数据库。两名评审员独立进行研究筛选、数据提取和评估。使用Cochrane协作网的工具评估偏倚风险。为了估计效应大小,使用Comprehensive Meta-Analysis和RevMan程序对研究进行荟萃分析。

结果

在识别出的18781篇出版物中,35篇符合纳入标准,25项研究用于估计心理教育干预的效应大小。效应大小(标准化均数差[SMD])存在异质性,分析中使用了随机效应模型。心理教育干预对生活质量有效(n = 2410,ES = 0.23;95%CI:0.090.37)、应对和自我效能有效(n = 179,ES = 0.68;95%CI:0.261.11)、焦虑有效(n = 1786,ES = -0.26;95%CI:-0.37-0.15)、抑郁有效(n = 1910,ES = -0.28;95%CI:-0.37-0.18)以及心理困扰有效(n = 2242,ES = -0.31;95%CI:-0.46~-0.17)。亚组分析表明,咨询是对生活质量最有效的干预措施,行为疗法对所有正负结果均为有效干预措施。除心理困扰外,未检测到发表偏倚。

结论

心理教育干预似乎对改善生活质量、应对能力和自我效能有效,且对减轻癌症幸存者的心理症状有效。尤其是行为疗法,通常对改善心理社会结局有效。然而,证据质量低、现有研究设计的变异性以及发表偏倚表明,未来应开展更多高质量试验。

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