The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
Int J Nurs Stud. 2021 Mar;115:103876. doi: 10.1016/j.ijnurstu.2021.103876. Epub 2021 Jan 12.
Advanced cancer is an incurable and life-threatening disease that poses a major challenge to patients' psychological and physical well-being. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy for managing health outcomes and inducing health-related behaviour changes. However, the components and modality of Acceptance and Commitment Therapy and its effectiveness on health outcomes for patients with advanced cancer remain unclear.
This review aimed to identify the main content, delivery mode, dosage and duration of Acceptance and Commitment Therapy, and to systematically summarise evidence regarding its application in patients with advanced cancer for improving physical and psychological outcomes and health-related quality of life.
Systematic review.
PubMed, British Nursing Index, Medline, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure and WANFANG Data were searched to identify eligible clinical trials.
Two reviewers independently assessed the eligibility of each study and extracted data. The Joanna Briggs Institute critical appraisal checklist was used to evaluate the risk of bias in the included studies. Narrative synthesis was used to present the findings of this review.
Six studies involving 261 participants were included in this review, including five randomised control trials and one with a pretest-posttest design. Two out of the five studies reported Acceptance and Commitment Therapy significantly reduced depressive symptoms and psychological distress post-intervention with a large effect size compared with usual care. One study indicated significant improvements in anxiety, sleep characteristics and health-related quality of life with a large effect size post-intervention. Non-significant changes in fatigue and pain were found. Intervention programmes with no more than four sessions had high adherence rates.
Acceptance and Commitment Therapy may be a beneficial way to improve depressive symptoms, anxiety, psychological distress, sleep characteristics and health-related quality of life in patients with advanced cancer. However, limited studies, small sample size and methodological heterogeneity weaken the evidence. More rigorous research using brief Acceptance and Commitment Therapy programmes should be conducted within larger samples to further confirm the effectiveness and evaluate its long-term effect on this population.
晚期癌症是一种无法治愈且危及生命的疾病，对患者的身心健康构成重大挑战。接纳与承诺疗法是一种基于正念的行为疗法，可用于管理健康结果并诱导与健康相关的行为改变。然而，接纳与承诺疗法的组成部分和模式及其对晚期癌症患者健康结果的有效性尚不清楚。
本综述旨在确定接纳与承诺疗法的主要内容、传递模式、剂量和持续时间，并系统总结其在晚期癌症患者中的应用证据，以改善身体和心理结果以及与健康相关的生活质量。
系统综述。
通过 PubMed、英国护理索引、Medline、PsycINFO、EMBASE、CINAHL、Cochrane 对照试验中心注册库、中国国家知识基础设施和万方数据检索，以确定合格的临床试验。
两位审查员独立评估每项研究的合格性并提取数据。采用 Joanna Briggs 研究所批判性评估清单评估纳入研究的偏倚风险。采用叙述性综合法呈现本综述的结果。
本综述纳入了 6 项研究，共 261 名参与者，包括 5 项随机对照试验和 1 项前后测设计研究。其中 2 项研究报告称，与常规护理相比，接纳与承诺疗法在干预后显著降低了抑郁症状和心理困扰，且具有较大的效应量。1 项研究表明，干预后焦虑、睡眠特征和与健康相关的生活质量有显著改善，且具有较大的效应量。疲劳和疼痛没有明显变化。疗程不超过 4 次的干预方案具有较高的依从性。
接纳与承诺疗法可能是改善晚期癌症患者抑郁症状、焦虑、心理困扰、睡眠特征和与健康相关的生活质量的有益方法。然而，有限的研究、小样本量和方法学异质性削弱了证据。应在更大的样本中开展更严格的、使用简短接纳与承诺疗法方案的研究，以进一步证实其对这一人群的有效性并评估其长期效果。
