非药物干预措施在管理癌症患者心理困扰中的应用：系统综述。
Non-pharmacological interventions to manage psychological distress in patients living with cancer: a systematic review.
机构信息
University of Leeds, Academic Unit of Palliative Care, Leeds, UK.
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
出版信息
BMC Palliat Care. 2023 Jul 6;22(1):88. doi: 10.1186/s12904-023-01202-8.
BACKGROUND
Psychological distress is common in patients with cancer; interfering with physical and psychological wellbeing, and hindering management of physical symptoms. Our aim was to systematically review published evidence on non-pharmacological interventions for cancer-related psychological distress, at all stages of the disease.
METHODS
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered on PROSPERO (CRD42022311729). Searches were made using eight online databases to identify studies meeting our inclusion criteria. Data were collected on outcome measures, modes of delivery, resources and evidence of efficacy. A meta-analysis was planned if data allowed. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT).
RESULTS
Fifty-nine studies with 17,628 participants were included. One third of studies included mindfulness, talking or group therapies. Half of all studies reported statistically significant improvements in distress. Statistically significant intervention effects on distress were most prevalent for mindfulness techniques. Four of these mindfulness studies had moderate effect sizes (d = -0.71[95% CI: -1.04, -0.37] p < 0.001) (d = -0.60 [95% CI: -3.44, -0.89] p < 0.001) (d = -0.77 [CI: -0.146, -1.954] p < 0.01) (d = -0.69 [CI: -0.18, -1.19] p = 0.008) and one had a large effect size (d = -1.03 [95% CI: -1.51, -0.54] p < 0.001). Heterogeneity of studies precluded meta-analysis. Study quality was variable and some had a high risk of bias.
CONCLUSIONS
The majority of studies using a mindfulness intervention in this review are efficacious at alleviating distress. Mindfulness-including brief, self-administered interventions-merits further investigation, using adequately powered, high-quality studies.
SYSTEMATIC REVIEW REGISTRATION
This systematic review is registered on PROSPERO, number CRD42022311729.
背景
癌症患者普遍存在心理困扰，这会干扰其身心健康，阻碍其对身体症状的管理。我们的目的是系统地回顾已发表的关于癌症相关心理困扰的非药物干预措施的证据，这些措施涵盖疾病的各个阶段。
方法
我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。该综述已在 PROSPERO（CRD42022311729）上注册。使用八个在线数据库进行搜索，以确定符合纳入标准的研究。收集关于结局测量、传递模式、资源和疗效证据的数据。如果数据允许，计划进行荟萃分析。使用混合方法评估工具（MMAT）评估质量。
结果
共纳入 59 项研究，涉及 17628 名参与者。三分之一的研究包括正念、谈话或小组疗法。一半的研究报告称心理困扰有统计学意义的改善。正念技术对心理困扰的干预效果最为显著。其中四项正念研究具有中度效应量（d=-0.71[95%CI:-1.04，-0.37]p<0.001）（d=-0.60[95%CI:-3.44，-0.89]p<0.001）（d=-0.77[CI:-0.146，-1.954]p<0.01）（d=-0.69[CI:-0.18，-1.19]p=0.008），一项研究具有较大效应量（d=-1.03[95%CI:-1.51，-0.54]p<0.001）。由于研究的异质性，无法进行荟萃分析。研究质量参差不齐，有些研究存在较高的偏倚风险。
结论
本综述中使用正念干预的大多数研究都能有效缓解困扰。正念——包括简短的、自我管理的干预措施——值得进一步研究，需要使用足够有力、高质量的研究。
系统综述注册
本系统综述已在 PROSPERO 上注册，编号为 CRD42022311729。
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