Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden.
Department Nutrition & Health, Louis Bolk Institute, Kosterijland 3-5, 3981 AJ, Bunnik, The Netherlands.
Support Care Cancer. 2020 May;28(5):2415-2429. doi: 10.1007/s00520-019-05058-8. Epub 2019 Sep 6.
To develop an evidence-based decision aid for parents of children with cancer and to help guide them in the use of complementary and alternative medicine (CAM) for cancer care.
This study had a mixed research design. The needs of parents were investigated by survey and focus group. A systematic review and meta-analysis were performed on the effectiveness of CAM using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Clinical experts were interviewed and a decision aid on CAM treatment for pain was developed.
Parents emphasized the importance of reliable information on CAM, focusing primarily on communication and a broad spectrum of complaints related to cancer treatment. The decision aid on CAM for pain included five modalities based on 11 randomized control trials (RCTs): hypnotherapy, mind-body techniques, massage, healing touch, and music therapy. Meta-analysis could be performed on hypnotherapy, which significantly reduced cancer-related procedural pain compared with standard care (MD, - 1.37; 95% CI, - 1.60, - 1.15; P < 0.00001) and attention control (MD, - 1.13; 95% CI, - 1.34, - 0.94; P < 0.00001), and massage, demonstrating no effect on pain compared with standard care (MD, - 0.77; 95% CI, - 1.82, 0.28; P = 0.15). Research evidence and supplementary information from clinical practice and patient were incorporated in a website-based decision aid.
An evidence-based decision aid was developed to support parents of children with cancer in making decisions about CAM for pain management. Next steps will be to expand the website to include additional childhood cancer-related complaints and to evaluate its use in practice.
为癌症患儿的家长开发一种基于证据的决策辅助工具，帮助他们在癌症护理中使用补充和替代医学（CAM）。
本研究采用混合研究设计。通过调查和焦点小组来调查家长的需求。使用 Grading of Recommendations Assessment, Development and Evaluation（GRADE）对 CAM 的有效性进行系统评价和荟萃分析。对临床专家进行了访谈，并开发了针对癌症疼痛治疗的 CAM 决策辅助工具。
家长强调了有关 CAM 的可靠信息的重要性，主要关注与癌症治疗相关的沟通和广泛的投诉。针对疼痛的 CAM 决策辅助工具包括基于 11 项随机对照试验（RCT）的五种模式：催眠疗法、身心技术、按摩、灵气治疗和音乐疗法。可以对催眠疗法进行荟萃分析，与标准护理相比，催眠疗法显著降低了癌症相关的程序疼痛（MD，-1.37；95%CI，-1.60，-1.15；P<0.00001）和注意力对照（MD，-1.13；95%CI，-1.34，-0.94；P<0.00001），而按摩与标准护理相比对疼痛没有影响（MD，-0.77；95%CI，-1.82，0.28；P=0.15）。研究证据以及来自临床实践和患者的补充信息被纳入了一个基于网站的决策辅助工具中。
为支持癌症患儿的家长在管理疼痛的 CAM 决策方面，开发了一种基于证据的决策辅助工具。下一步将扩大该网站，纳入更多与儿童癌症相关的投诉，并评估其在实践中的应用。
