1 Department of Pediatrics, Division of Pediatric Blood & Marrow Transplant, Duke University Medical Center, Durham, North Carolina.
2 Department of Hematology/Oncology & Bone Marrow Transplant, Children's Mercy Hospital, Kansas City, Missouri.
J Adolesc Young Adult Oncol. 2019 Apr;8(2):105-113. doi: 10.1089/jayao.2018.0111. Epub 2018 Nov 29.
The purpose of this systematic review is to (1) synthesize evidence facilitators and barriers affecting adolescent willingness to communicate symptoms to health care providers (HCPs) and (2) create practice recommendations. The PICOT (Population, Intervention, Comparison, Outcome, Time) question guiding the review was, among adolescents with cancer, what factors affect their willingness to communicate symptoms to HCPs? Three databases, PubMed, CINAHL, and PsychINFO, were searched using keywords from the PICOT question. Inclusion criteria included original research studies with samples of at least 51% adolescents aged 10-18 years who were receiving or had received cancer treatment. Studies were included that evaluated outcomes related to willingness to communicate in general as well as communication of specific treatment symptoms. Exclusion criteria included systematic reviews and publications emphasizing cancer screening, cancer prevention, survivorship, or decision making. A total of 11 studies were included in the systematic review. Two of the studies focused on symptom communication; the remaining nine studies focused on general communication or the overlap between general and symptom communication. Barriers to symptom and/or general communication included negative expectations, health-related uncertainty, ambiguousness with assessments, unfamiliarity, restriction of information, perceived negative provider characteristics/behaviors, adolescent circumstance, worry about others' perceptions, and provider approach. Facilitators to symptom and/or general communication included open communication, perceived favorable provider characteristics/behaviors, seasoned adolescent, and patient-provider rapport. Five practice recommendations were developed from the evidence that supports general and symptom communication between adolescents who are receiving or have completed cancer treatment and their HCPs.
(1) 综合影响青少年向医疗保健提供者（HCP）报告症状的意愿的因素；(2) 制定实践建议。指导本评价的 PICOT（人群、干预、比较、结果、时间）问题是，在患有癌症的青少年中，哪些因素影响他们向 HCP 报告症状的意愿？使用 PICOT 问题中的关键词，在三个数据库（PubMed、CINAHL 和 PsychINFO）中进行了搜索。纳入标准包括样本中至少有 51%的青少年年龄在 10-18 岁之间，正在接受或已经接受癌症治疗的原始研究。评估与一般沟通意愿以及特定治疗症状沟通相关的结果的研究包括在内。排除标准包括系统评价和强调癌症筛查、癌症预防、生存和决策的出版物。共有 11 项研究纳入了系统评价。其中两项研究关注症状沟通；其余九项研究关注一般沟通或一般沟通和症状沟通的重叠。症状和/或一般沟通的障碍包括负面期望、与健康相关的不确定性、评估的模糊性、不熟悉、信息限制、感知到的负面提供者特征/行为、青少年情况、担心他人的看法以及提供者的方法。促进症状和/或一般沟通的因素包括开放的沟通、感知到的有利提供者特征/行为、经验丰富的青少年和医患关系融洽。从支持正在接受或已完成癌症治疗的青少年与 HCP 之间进行一般和症状沟通的证据中，制定了五项实践建议。
