Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
Psychooncology. 2018 Jul;27(7):1675-1694. doi: 10.1002/pon.4684. Epub 2018 Apr 2.
International guidelines recommend that rehabilitation be offered to people with thoracic cancer to improve symptoms, function, and quality of life. When rehabilitation interventions require a change in behaviour, the use of theory and behaviour change techniques (BCTs) enhance participation. Our objective was to systematically identify BCTs and examine their use in relation to the Capability, Opportunity, Motivation-Behaviour model and known enablers and barriers to engagement in this population.
Bibliographic databases and grey literature were searched for controlled trials of rehabilitation interventions for adults with lung cancer or mesothelioma, with no limits on language or date. Data on the application of behavioural change theory and BCTs were extracted, categorised using the BCT Taxonomy (v1) and described according to the "Capability, Opportunity, Motivation-Behaviour" model.
Twenty-seven studies of exercise (n = 15) and symptom self-management (n = 12) interventions were identified. Four studies reported use of behavioural change theory; one study used symptom theory. Across studies, a mean (range) of 7 (1-18) BCTs were used, representing 26 of 93 possible BCTs included in the taxonomy. Most frequent enabling BCTs were "instructions on how to perform behaviours" (74%), "behavioural practice" (74%), and "action planning" (70%). BCTs to address barriers were less frequent and included "information about health consequences" (22%) and "verbal persuasion about capability" (7%) to change perceptions about benefits, burden, and harms.
The application of behavioural change tools appears sub-optimal in this group of patients. Explicit use of BCTs targeting behavioural components upon which outcomes depend may improve the uptake and effectiveness of rehabilitation interventions.
国际指南建议为胸癌患者提供康复治疗，以改善症状、功能和生活质量。当康复干预需要改变行为时，应用理论和行为改变技术（BCTs）可以增强参与度。我们的目标是系统地识别 BCTs，并研究它们在与能力、机会、动机-行为模型以及已知促进和阻碍该人群参与的因素的关系中的应用。
检索了针对成人肺癌或间皮瘤的康复干预的对照试验的文献数据库和灰色文献，不限制语言或日期。提取了关于行为改变理论和 BCT 应用的数据，使用行为改变分类法（v1）进行分类，并根据“能力、机会、动机-行为”模型进行描述。
确定了 27 项关于运动（n=15）和症状自我管理（n=12）干预的研究。四项研究报告了行为改变理论的应用；一项研究使用了症状理论。在所有研究中，平均（范围）使用了 7（1-18）个 BCT，代表了分类法中 93 个可能的 BCT 中的 26 个。最常见的促进 BCT 是“关于如何执行行为的指导”（74%）、“行为实践”（74%）和“行动计划”（70%）。解决障碍的 BCT 则较少见，包括“关于健康后果的信息”（22%）和“关于能力的口头说服”（7%），以改变对益处、负担和危害的看法。
在这组患者中，行为改变工具的应用似乎并不理想。明确应用针对康复干预结果所依赖的行为成分的 BCT 可能会提高康复干预的参与度和效果。
