Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
Depress Anxiety. 2020 Mar;37(3):234-246. doi: 10.1002/da.22980. Epub 2019 Dec 6.
Dignity is a vitally important aspect of the lives of advanced cancer patients. We conducted a systematic review and meta-analysis of the effectiveness of dignity therapy in this patient population.
We searched for randomized controlled trials comparing dignity therapy versus standard care for patients with advanced cancer in five comprehensive databases (March 2019), two clinical trial registries and one gray literature database (August 2019). The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0. We used GRADE approach to assess the certainty of evidence. Meta-analysis was performed with RevMan version 5.3. Outcomes of interest included anxiety, depression, dignity-related distress and quality of life (QoL).
Ten trials evaluating 904 patients (control, 449; experimental, 455) were identified. Six trials included patients with different types of advanced cancer, and four trials included patients with a single advanced cancer (lung cancer [20%], breast cancer [10%], and hepatocellular carcinoma [10%]). Compared with the standard care, dignity therapy decreased the score of anxiety, depression, and dignity-related distress of the advanced cancer patients (SMD = -1.07, 95% CI: [-1.57, -0.58], p < .05; SMD = -1.31, 95% CI: [-1.92, -0.70], p < .05; MD = -7.30, 95% CI: [- 12.04, - 2.56], p < .05). In addition, no significant differences were found in the patient's QoL (p > .05).
Very low certainty evidence demonstrated that dignity therapy might be a promising treatment, especially in reducing anxiety and depression in advanced cancer patients.
尊严是晚期癌症患者生活中至关重要的一个方面。我们对尊严疗法在这一患者群体中的疗效进行了系统评价和荟萃分析。
我们在五个综合数据库(2019 年 3 月)、两个临床试验注册处和一个灰色文献数据库中搜索了比较尊严疗法与晚期癌症患者标准护理的随机对照试验(2019 年 8 月)。使用 Cochrane 手册第 5.1.0 版推荐的偏倚风险工具评估研究质量。我们使用 GRADE 方法评估证据的确定性。使用 RevMan 版本 5.3 进行荟萃分析。感兴趣的结局包括焦虑、抑郁、与尊严相关的痛苦和生活质量(QoL)。
共确定了 10 项评估 904 例患者(对照组 449 例,实验组 455 例)的试验。6 项试验纳入了多种类型的晚期癌症患者,4 项试验纳入了单一类型的晚期癌症患者(肺癌 [20%]、乳腺癌 [10%]、肝癌 [10%])。与标准护理相比,尊严疗法降低了晚期癌症患者的焦虑、抑郁和与尊严相关的痛苦评分(SMD=-1.07,95%CI:[-1.57,-0.58],p<.05;SMD=-1.31,95%CI:[-1.92,-0.70],p<.05;MD=-7.30,95%CI:[-12.04,-2.56],p<.05)。此外,患者的 QoL 无显著差异(p>.05)。
极低确定性证据表明,尊严疗法可能是一种有前途的治疗方法,尤其在减轻晚期癌症患者的焦虑和抑郁方面。