Iberoamerican Cochrane Centre (IbCC)-Sant Pau Biomedical Research Institute (IIB-Sant Pau), C/ Sant Antoni Maria Claret 167. Pabellón 18, Planta 0, 08025, Barcelona, Spain.
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Patient. 2021 Nov;14(6):719-740. doi: 10.1007/s40271-021-00514-2. Epub 2021 Apr 19.
BACKGROUND: Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. METHODS: We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. RESULTS: We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. CONCLUSION: The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions.
背景：自我管理（SM）干预是由医疗保健专业人员、同伴或非专业人员系统提供的支持性干预措施，旨在提高患者管理慢性病的技能和信心。我们有两个目标：（1）总结 4 种慢性病中患者及其照顾者（非正式照顾者和医疗保健专业人员）对 SM 的偏好和经验；（2）从这些角度确定和描述 SM 干预的相关结果。
方法：我们对综述进行了混合方法范围审查。我们在三个数据库中搜索了截至 2020 年 12 月的定量、定性或混合方法综述，以探讨 2 型糖尿病（T2DM）、肥胖症、慢性阻塞性肺疾病（COPD）和心力衰竭（HF）患者对 SM 的偏好或经验。定量数据进行了叙述性综合，定性数据采用三步描述性主题综合方法进行分析。确定的主题被归类为 SM 干预的结果或可修改因素。
结果：我们纳入了 148 篇综述，涵盖 T2DM（n = 53 [35.8%]）、肥胖症（n = 20 [13.5%]）、COPD（n = 32 [21.6%]）、HF（n = 38 [25.7%]）以及多种疾病（n = 5 [3.4%]）。我们确定了 12 个主要主题。其中 8 个描述了 SM 的过程（疾病进展、SM 行为、社会支持、与医疗保健专业人员的互动、获得医疗保健、患者的成本、文化定义的角色和观念以及健康知识），4 个描述了他们对 SM 干预的经验（干预的感知益处、个性化护理、与同伴的社区感以及设备的可用性）。大多数主题和子主题被归类为 SM 干预的结果。
结论：SM 的过程塑造了患者及其照顾者对 SM 干预的看法。他们的观点受到干预的感知益处、与同伴的社区感、干预的可用性以及个性化护理水平的影响。我们的研究结果可以为选择患者重要的结果、决策过程（包括制定建议）以及 SM 干预的设计和实施提供信息。
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