School of Women's and Children's Health, University of New South Wales (UNSW) Sydney, Randwick, Australia.
Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.
Oncologist. 2020 Feb;25(2):e351-e372. doi: 10.1634/theoncologist.2019-0184. Epub 2019 Oct 25.
The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision.
We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome.
Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects.
SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies.
Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.
美国医学研究所建议将生存护理计划(SCP)纳入癌症生存护理。我们的荟萃分析比较了 SCP 与无 SCP(对照)条件下癌症生存者的患者报告结局。我们的系统评价从生存者和医疗保健专业人员的角度检查了实施 SCP 的可行性,以及 SCP 对医疗保健专业人员知识和生存护理提供的影响。
我们在七个在线数据库中(从成立到 2018 年 4 月 22 日)搜索了评估 SCP 可行性和医疗保健专业人员结果的文章。比较 SCP 接受者与对照组患者报告结局的随机对照试验符合荟萃分析的条件。我们使用每个患者报告结局的汇总标准化均数差进行了随机效应荟萃分析。
有 8 篇文章符合荟萃分析的条件(n = 1,286 名生存者),50 篇文章符合系统评价的条件(n = 18,949 名生存者;n = 3,739 名医疗保健专业人员)。在干预后 6 个月时,SCP 接受者与对照组在自我报告的癌症和生存知识、身体功能、对信息提供的满意度或自我效能方面没有差异,在 12 个月时在焦虑、癌症特异性困扰、抑郁或对随访护理的满意度方面也没有差异。SCP 似乎是可以接受的,并且可能会提高生存者对医疗建议的依从性以及医疗保健专业人员对生存护理和晚期影响的知识。
SCP 似乎可行,但不能改善生存者的患者报告结局。研究应确定这是由于 SCP 无效、实施问题还是比较有效性研究的设计不当所致。
有几个组织建议癌症幸存者在癌症治疗后接受生存护理计划(SCP);然而,SCP 对癌症幸存者和医疗保健专业人员的影响尚不清楚。本系统评价表明,尽管 SCP 似乎是可行的,并且可能会提高医疗保健专业人员对晚期影响和生存护理的知识,但没有证据表明 SCP 会影响癌症幸存者的患者报告结局。为了证明持续实施 SCP 的合理性,应进行额外的研究来评估 SCP 的实施和比较有效性研究的研究设计。还可能需要讨论 SCP 根本无效的可能性。