Department of Clinical Psychology and Psychotherapy, Ulm University, Germany.
Psychooncology. 2018 Nov;27(11):2531-2545. doi: 10.1002/pon.4829. Epub 2018 Aug 2.
To synthesize the evidence of existential interventions in adult patients with cancer.
Embase, MEDLINE, CENTRAL, CINAHL, PsycINFO, PSYNDEX, and the WHO ICTRP were searched up until 26 January 2018. Eligibility criteria for studies were (1) adult patients with cancer, (2) evaluation of existential interventions, (3) compared with active/non-active control, (4) assessing relevant spiritual, psychological, or physical outcomes, and (5) conducted as randomized controlled trials. Standardized mean differences (Hedges' g) were calculated, and meta-analyses were conducted using random effects models. Effects were aggregated within four time horizons (post-treatment; ≤3 months; ≤6 months; >6 months). Heterogeneity was assessed by forest plots and I . Risk of bias was assessed using the Cochrane Risk of Bias Tool. This review has been registered with Prospero (CRD42016042895).
A total of 3461 records were identified, of which 30 unique studies (3511 participants) were included in the review and 24 studies were included in meta-analyses. Existential interventions showed significant effects on existential well-being (g = 0.52; CI[0.13; 0.91; k = 10; I = 85%) and quality of life (g = 0.21; CI[0.01; 0.42]; k = 17; I = 75%) at post-treatment, on hope at post-treatment (g = 0.43; CI[0.12; 0.74]; k = 12; I = 86%) and after 6 months (g = 0.25; CI[0.02; 0.48]; k = 3; I = 0%) and on self-efficacy at post-treatment (g = 0.50; CI[0.09; 0.90]; k = 2; I = 0%). No significant effects were found on the remaining outcomes and time points. Significant moderator effects were found for professional background of therapists, intervention concept, number of sessions, and setting.
This systematic review and meta-analysis provides evidence that adult patients with cancer across all stages and types benefit from existential interventions. Future research should strive towards a higher standardization in particular with respect to outcome assessments.
综合成人癌症患者存在主义干预的证据。
检索 Embase、MEDLINE、CENTRAL、CINAHL、PsycINFO、PSYNDEX 和世界卫生组织 ICTRP，截至 2018 年 1 月 26 日。研究纳入标准为：（1）成人癌症患者；（2）评估存在主义干预；（3）与积极/非积极对照比较；（4）评估相关的精神、心理或生理结局；（5）进行随机对照试验。计算标准化均数差值（Hedges' g），并使用随机效应模型进行荟萃分析。在四个时间点（治疗后；≤3 个月；≤6 个月；>6 个月）内汇总效应。通过森林图和 I 评估异质性。使用 Cochrane 偏倚风险工具评估偏倚风险。本综述已在 Prospero（CRD42016042895）注册。
共确定了 3461 条记录，其中 30 项独特的研究（3511 名参与者）纳入综述，24 项研究纳入荟萃分析。存在主义干预在治疗后即刻对存在主义幸福感（g=0.52；CI[0.13；0.91；k=10；I=85%）和生活质量（g=0.21；CI[0.01；0.42]；k=17；I=75%）、治疗后即刻的希望（g=0.43；CI[0.12；0.74]；k=12；I=86%）和 6 个月后（g=0.25；CI[0.02；0.48]；k=3；I=0%）以及治疗后即刻的自我效能（g=0.50；CI[0.09；0.90]；k=2；I=0%）方面有显著效果。在其他结局和时间点没有发现显著效果。治疗师的专业背景、干预概念、疗程数和治疗环境存在显著的调节效应。
本系统评价和荟萃分析提供了证据，表明处于各阶段和类型的癌症成年患者都能从存在主义干预中获益。未来的研究应努力提高标准化程度，特别是在评估结果方面。
