University of Technology, Cyprus and DOCENT; Department of Nursing Studies, University of Turku, Finland.
Imperial College Healthcare NHS Trust, London, UK.
Int J Nurs Stud. 2018 Oct;86:36-43. doi: 10.1016/j.ijnurstu.2018.05.014. Epub 2018 May 26.
Advances in research and technology coupled with an increased cancer incidence and prevalence have resulted in significant expansion of cancer nurse role, in order to meet the growing demands and expectations of people affected by cancer (PABC). Cancer nurses are also tasked with delivering an increasing number of complex interventions as a result of ongoing clinical trials in cancer research. However much of this innovation is undocumented, and we have little insight about the nature of novel interventions currently being designed or delivered by cancer nurses.
To identify and synthesise the available evidence from clinical trials on interventions delivered or facilitated by cancer nurses.
A systematic review of randomised controlled trials (RCT), quasi-RCTs and controlled before and after studies (CBA) of cancer nursing interventions aimed at improving the experience and outcomes of PABC. Ten electronic databases (CENTRAL, MEDLINE, AMED, CINAHL, EMBASE, Epistemonikos, CDSR, DARE, HTA, WHO ICTRP) were searched between 01 January 2000 and 31 May 2016. No language restrictions were applied. Bibliographies of selected studies and relevant Cochrane reviews were also hand-searched. Interventions delivered by cancer nurses were classified according to the OMAHA System. Heat maps were used to highlight the volume of evidence available for different cancer groups, intervention types and stage of cancer care continuum.
The search identified 22,450 records; we screened 16,169 abstracts and considered 925 full papers, of which 214 studies (247,550 participants) were included in the evidence synthesis. The majority of studies were conducted in Europe (n = 79) and USA (n = 74). Interventions were delivered across the cancer continuum from prevention and risk reduction to survivorship, with the majority of interventions delivered during the treatment phase (n = 137). Most studies (131/214) had a teaching, guidance or counselling component. Cancer nurse interventions were targeted at primarily breast, prostate or multiple cancers. No studies were conducted in brain, sarcoma or other rare cancer types. The majority of the studies (n = 153) were nurse-led and delivered by specialist cancer nurses (n = 74) or advanced cancer nurses (n = 29), although the quality of reporting was poor.
To the best of our knowledge, this is the first review to synthesise evidence from intervention studies across the entire cancer spectrum. As such, this work provides new insights into the nature of the contribution that cancer nurses have made to evidence-based innovations, as well as highlighting areas in which cancer nursing trials can be developed in the future.
研究和技术的进步，加上癌症发病率和患病率的增加，导致了癌症护士角色的显著扩展，以满足癌症患者（PABC）日益增长的需求和期望。癌症护士还负责提供越来越多的复杂干预措施，因为癌症研究中的临床试验在不断进行。然而，其中许多创新都没有记录在案，我们对癌症护士目前正在设计或提供的新干预措施的性质知之甚少。
确定并综合临床试验中关于癌症护士提供或促进的干预措施的现有证据。
对旨在改善 PABC 体验和结果的癌症护理干预措施的随机对照试验（RCT）、准 RCT 和对照前后研究（CBA）进行系统评价。检索了 10 个电子数据库（CENTRAL、MEDLINE、AMED、CINAHL、EMBASE、Epistemonikos、CDSR、DARE、HTA、WHO ICTRP），检索时间为 2000 年 1 月 1 日至 2016 年 5 月 31 日。未对语言进行限制。还对选定研究的参考文献和相关 Cochrane 综述进行了手工检索。根据 OMAHA 系统对癌症护士提供的干预措施进行分类。热图用于突出不同癌症群体、干预类型和癌症护理连续体阶段可用证据的数量。
搜索共确定了 22450 条记录；我们筛选了 16169 篇摘要，并考虑了 925 篇全文，其中 214 项研究（247550 名参与者）纳入证据综合分析。大多数研究在欧洲（n=79）和美国（n=74）进行。干预措施贯穿整个癌症连续体，从预防和降低风险到生存，大多数干预措施在治疗阶段进行（n=137）。大多数研究（131/214）有教学、指导或咨询组成部分。癌症护士的干预措施主要针对乳腺癌、前列腺癌或多种癌症。没有研究在脑癌、肉瘤或其他罕见癌症类型中进行。大多数研究（n=153）是由护士主导的，由专门的癌症护士（n=74）或高级癌症护士（n=29）提供，尽管报告质量较差。
据我们所知，这是首次对整个癌症谱的干预研究进行综合证据的综述。因此，这项工作提供了对癌症护士对循证创新所做贡献的性质的新见解，并突出了未来癌症护理试验可以发展的领域。
