College of Life Sciences, University of Leicester, University Road, Leicester, UK.
School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK.
Res Social Adm Pharm. 2022 Nov;18(11):3870-3883. doi: 10.1016/j.sapharm.2022.05.011. Epub 2022 May 25.
Supporting cancer survivors in self-management can empower them to take an active role in managing the long-term physical and psychosocial consequences of cancer treatment. Healthcare practitioners are key to supporting patients to self-manage, however, they do not routinely engage in these discussions. This review aimed to establish what works for whom and in what circumstances in relation to facilitating healthcare practitioners to provide self-management support in people living with long-term consequences of cancer treatment.
The review follows five steps: define the review's scope, develop initial programme theories, evidence search, selection and appraisal, and data extraction and synthesis. Database searches of Medline, EMBASE, CINAHL, Scopus, PsycINFO, ERIC and AMED databases, to September 2019 were supplemented with practitioner surveys. Insights into the mechanisms that operate in particular contexts to produce successful outcomes were illustrated using realist programme theories, developed using the Theoretical Domains Framework. Data selection was based on relevance and rigour. Data were extracted and synthesised iteratively to illuminate causal links between contexts, mechanisms and outcomes.
Five programme theories were identified from 20 included articles and seven practitioner surveys: practitioners will engage patients in discussions about self-management if they have appropriate (1) knowledge and (2) consultations skills, (3) a clear understanding of their self-management support role and responsibilities, and if (4) organisational strategies and (5) health system configuration enable integration into routine care. The mechanisms facilitating practitioners to support self-management were practitioner confidence, mutual trust and shared responsibility between practitioners and cancer survivors, organisational prioritisation and ease of delivery of self-management support.
The findings articulate the necessary components for embedding self-management support into routine cancer care. Operationalisation of these components into effective self-management support interventions will require reconfiguration of pathways and adaptation for local context, using strategies such as quality improvement and co-design to guide intervention development, implementation and evaluation.
支持癌症幸存者进行自我管理，可以使他们能够积极应对癌症治疗带来的长期身体和心理社会后果。医疗保健从业者是支持患者进行自我管理的关键，但他们通常不会进行这些讨论。本综述旨在确定在哪些情况下，哪些因素可以促使医疗保健从业者为接受癌症治疗后长期存在后果的患者提供自我管理支持。
本综述遵循五个步骤：定义综述范围、制定初始方案理论、证据搜索、选择和评估以及数据提取和综合。对 Medline、EMBASE、CINAHL、Scopus、PsycINFO、ERIC 和 AMED 数据库进行了数据库搜索，并补充了从业者调查。使用理论领域框架开发的真实主义方案理论，说明了在特定情况下起作用的机制，以产生成功的结果。基于相关性和严谨性选择数据。数据提取和综合是迭代进行的，以阐明背景、机制和结果之间的因果关系。
从 20 篇纳入的文章和 7 项从业者调查中确定了 5 个方案理论：如果从业者具备适当的（1）知识和（2）咨询技能、（3）清楚了解其自我管理支持角色和责任，并且（4）组织策略和（5）卫生系统配置能够将其整合到常规护理中，那么他们就会与患者讨论自我管理问题。促进从业者支持自我管理的机制包括从业者的信心、从业者和癌症幸存者之间的相互信任和共同责任、组织的重点和自我管理支持的交付便利性。
这些发现阐明了将自我管理支持纳入常规癌症护理的必要组成部分。为了将这些组成部分有效地应用于自我管理支持干预措施，需要根据当地情况对其进行重新配置和调整，例如使用质量改进和共同设计等策略来指导干预措施的开发、实施和评估。
