Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia.
BMJ Support Palliat Care. 2020 Sep;10(3):276-286. doi: 10.1136/bmjspcare-2019-002120. Epub 2020 Jun 4.
To examine the effects of nurse-led interventions on the health-related quality of life, symptom burden and self-management/behavioural outcomes in women with breast cancer.
Cochrane Controlled Register of Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Embase databases were searched (January 1999 to May 2019) to identify randomised controlled trials (RCTs) and controlled before-and-after studies of interventions delivered by nurses with oncology experience for women with breast cancer. Risk of bias was evaluated using the . Intervention effects were synthesised by cancer trajectory using .
Thirty-one RCTs (4651 participants) were included. All studies were at risk of bias mainly due to inherent limitations such as lack of blinding and self-report data. Most studies (71%; n=22) reported at least one superior intervention effect. There were no differences in all outcomes between those who receive nurse-led care versus those who received physical led or usual discharge care. Compared with control interventions, there were superior (63%) and (100%) intervention effects on symptom burden during treatment and survivorship. Effects of these interventions on health-related quality of life and symptom self-management/behavioural outcomes were inconsistent.
There is consistent evidence from RCTs that nurse-led interventions are as safe and effective as physician-led care and strong evidence that nurse-led and interventions are effective for symptom management. Future studies should ensure the incorporation of health-related quality of life and self-management/behavioural outcomes and consider well-designed attentional placebo controls to blind participants for self-report outcomes.
The International Prospective Register of Systematic Reviews (PROSPERO): CRD42020134914).
探讨护士主导干预对乳腺癌女性健康相关生活质量、症状负担和自我管理/行为结果的影响。
检索 Cochrane 对照试验注册库（CENTRAL）、护理学和联合健康文献累积索引（CINAHL）、Medline 和 Embase 数据库（1999 年 1 月至 2019 年 5 月），以确定有肿瘤学经验的护士提供的干预措施的随机对照试验（RCT）和对照前后研究，纳入对象为乳腺癌女性。采用. 评估偏倚风险。采用. 按癌症轨迹综合干预效果。
纳入 31 项 RCT（4651 名参与者）。所有研究均存在偏倚风险，主要是由于缺乏盲法和自我报告数据等固有局限性。大多数研究（71%；n=22）报告了至少一个优势干预效果。与接受护士主导护理的患者相比，接受物理治疗主导或常规出院护理的患者在所有结局上均无差异。与对照干预相比，在治疗和生存期间，护士主导的症状负担具有更优的干预效果（63%）和（100%）。这些干预措施对健康相关生活质量和症状自我管理/行为结果的影响不一致。
RCT 的一致证据表明，护士主导的干预与医生主导的护理同样安全有效，并且有强有力的证据表明，护士主导的和症状管理干预对症状管理有效。未来的研究应确保纳入健康相关生活质量和自我管理/行为结果，并考虑精心设计的注意安慰剂对照，以对自我报告结局进行盲法。
国际前瞻性系统评价注册库（PROSPERO）：CRD42020134914）。
