癌症相关疲劳的自我管理支持：一项系统综述。

Self-management support for cancer-related fatigue: A systematic review.

作者信息

Agbejule Oluwaseyifunmi Andi, Hart Nicolas H, Ekberg Stuart, Crichton Megan, Chan Raymond Javan

机构信息

Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia; Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia; Caring Futures Institute, College of Nursing and Allied Health, Flinders University, Bedford Park, South Australia 5042, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia 6027, Australia; Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia 6160, Australia.

出版信息

Int J Nurs Stud. 2022 May;129:104206. doi: 10.1016/j.ijnurstu.2022.104206. Epub 2022 Feb 24.

DOI:10.1016/j.ijnurstu.2022.104206

PMID:35279591

Abstract

OBJECTIVES

To describe and examine the theories, components, and effectiveness of self-management support interventions for individuals experiencing cancer-related fatigue.

METHODS

A systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement. CINAHL, PubMed, Cochrane CENTRAL, and EMBASE were searched (from inception to June 2021) for randomised controlled trials examining self-management support interventions for managing cancer-related fatigue. Data were screened, extracted, and appraised by two authors. Data extraction was guided by the Self-management Support Taxonomy (i.e., a modified version of the Practical Reviews in Self-Management Support Taxonomy tailored to cancer). The Revised Cochrane Risk of Bias tool was used for study appraisal. A critical narrative synthesis was conducted.

RESULTS

Fifty-one papers representing 50 different studies (n = 7383) were identified. Most interventions were delivered post-treatment (40%) using in-person (i.e., 'face-to-face') encounters (40%), and were facilitated by health professionals (62%). A range of intervention approaches and self-management support strategies were used across studies. The average number of Self-management Support Taxonomy components used across studies was 6.1 (of 14). Thirty-one studies (62%) described a specific behavior change theory to guide their self-management support intervention development. Twenty-nine studies (n = 29/50; 58%) reported a positive intervention effect for fatigue immediately post-intervention. Of these 29 studies, 10 (34%) reported at least one sustained positive effect on fatigue over follow-up periods between two and 12 months.

CONCLUSIONS

Self-management support that is delivered after cancer treatment, facilitated by health professionals, and incorporating at least one in-person contact appears to produce the most favourable fatigue and behavioral outcomes. However, further work is needed to better understand how individual self-management support strategies and the application of a behavioral theory influence behavior change. Program developers should guide self-management support with a behavioral theory, and describe their theory application in intervention development, implementation, and evaluation; ensure facilitators receive adequate support training; and seek the delivery preferences of cancer survivors. Future research should incorporate adequate follow-up to sufficiently evaluate the impact of programs on cancer-related fatigue and associated self-management behaviors. Findings from this review are relevant to all healthcare professionals, but are of most relevance to nurses as the largest cancer care workforce with a key role in delivering self-management support.

摘要

目的

描述并探讨针对癌症相关疲劳患者的自我管理支持干预措施的理论、组成部分及有效性。

方法

本系统评价依据《系统评价与Meta分析优先报告条目2020声明》进行报告。检索了CINAHL、PubMed、Cochrane CENTRAL和EMBASE（从数据库建库至2021年6月），以查找关于自我管理支持干预措施以管理癌症相关疲劳的随机对照试验。由两位作者对数据进行筛选、提取和评估。数据提取以自我管理支持分类法（即针对癌症量身定制的自我管理支持分类法实用评价的修订版）为指导。使用修订后的Cochrane偏倚风险工具进行研究评估。进行了批判性叙述性综合分析。

结果

共识别出51篇论文，代表50项不同研究（n = 7383）。大多数干预措施在治疗后实施（40%），采用面对面接触方式（40%），并由卫生专业人员提供协助（62%）。各项研究采用了一系列干预方法和自我管理支持策略。各研究使用的自我管理支持分类法组成部分的平均数量为6.1个（共14个）。31项研究（62%）描述了一种特定的行为改变理论，以指导其自我管理支持干预措施的制定。29项研究（n = 29/50；58%）报告干预后立即对疲劳产生了积极的干预效果。在这29项研究中，10项（34%）报告在2至12个月的随访期内对疲劳至少有一项持续的积极影响。

结论

癌症治疗后由卫生专业人员提供协助并至少包含一次面对面接触的自我管理支持，似乎能产生最有利的疲劳和行为结果。然而，需要进一步开展工作，以更好地理解个体自我管理支持策略以及行为理论的应用如何影响行为改变。项目开发者应以行为理论指导自我管理支持，并在干预措施的制定、实施和评估中描述其理论应用；确保协助者接受充分的支持培训；并了解癌症幸存者的交付偏好。未来的研究应纳入充分的随访，以充分评估项目对癌症相关疲劳及相关自我管理行为的影响。本综述的结果与所有医疗保健专业人员相关，但对护士最为相关，因为护士是最大的癌症护理人员群体，在提供自我管理支持方面发挥着关键作用。