Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/Avicena s/n, Sevilla, Spain.
CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMMS) Research Group, Andalusia, Spain.
Support Care Cancer. 2023 Aug 16;31(9):523. doi: 10.1007/s00520-023-07986-y.
To summarize the evidence on the effectiveness that psychological and/or spiritual interventions may have to change the levels of meaning, measured with the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), in adults diagnosed with cancer.
Systematic review with meta-analysis and meta-regression. CINAHL (via EBSCOhost), Embase, PubMed, PsycINFO (via ProQuest), and the Cochrane Library were searched from inception to 21 October 2022. Manual searches were conducted. Only randomized clinical trials (RCTs) were included. The risk of bias was assessed with the Cochrane Risk of Bias tool 2. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to judge the certainty of the evidence.
Eight RCTs were included (N = 1682). Although some individual studies showed positive effects to enhance meaning using mindfulness or dignity therapy, the overall and individual meta-analyses showed a lack of effect of psychological and spiritual interventions in comparison to comparator interventions (MD (95%CI) = -0.19 (-0.45 to 0.06), p = 0.11, Tau= 0.0015, I= 2%). Publication bias was undetected (Egger's test = 0.35). Furthermore, no RCTs were judged to have a low risk of bias and the overall certainty of the evidence was judged as low. Meta-regression and subgroups meta-analyses also found possible sources of heterogeneity such as some cancer characteristics, the educational stage, or the religious affiliation.
Despite some RCTs may show promising results following mindfulness or dignity therapy, no effects were observed in the meta-analysis. Moreover, important methodological and clinical concerns precluded us to make sound clinical recommendations with the available evidence. OPEN SCIENCE FRAMEWORK DOI REGISTRATION: https://doi.org/10.17605/OSF.IO/4YMTK .
总结心理和/或精神干预可能对改变癌症患者的意义水平（用慢性疾病治疗的功能评估-精神幸福感量表（FACIT-Sp）衡量）的有效性证据。
系统综述，包括 meta 分析和 meta 回归。从建库到 2022 年 10 月 21 日，在 CINAHL（通过 EBSCOhost）、Embase、PubMed、PsycINFO（通过 ProQuest）和 Cochrane 图书馆进行了检索，并进行了手工检索。仅纳入随机临床试验（RCT）。使用 Cochrane 偏倚风险工具 2 评估偏倚风险。采用推荐评估、制定与评价分级（GRADE）方法评估证据的确定性。
纳入了 8 项 RCT（N=1682）。尽管一些单独的研究表明，正念或尊严疗法可以增强意义，但总体和个体 meta 分析显示，与对照干预相比，心理和精神干预没有效果（MD（95%CI）=-0.19（-0.45 至 0.06），p=0.11，Tau=0.0015，I=2%）。未检测到发表偏倚（Egger 检验=0.35）。此外，没有 RCT 被判定为低偏倚风险，证据的总体确定性被判定为低。Meta 回归和亚组 meta 分析也发现了可能的异质性来源，如某些癌症特征、教育阶段或宗教信仰。
尽管一些 RCT 可能表明正念或尊严疗法有希望的结果，但 meta 分析并未观察到效果。此外，重要的方法学和临床问题使我们无法根据现有证据提出合理的临床建议。
开放科学框架 DOI 注册：https://doi.org/10.17605/OSF.IO/4YMTK 。
