远程医疗对姑息治疗患者非正式照护者的影响：系统评价和荟萃分析。

Effects of Telemedicine on Informal Caregivers of Patients in Palliative Care: Systematic Review and Meta-Analysis.

机构信息

Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China.

College of Nursing, China Medical University, Shenyang, China.

出版信息

JMIR Mhealth Uhealth. 2024 Apr 8;12:e54244. doi: 10.2196/54244.

DOI:10.2196/54244

PMID:38602303

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11024400/

Abstract

BACKGROUND

Telemedicine technology is a rapidly developing field that shows immense potential for improving medical services. In palliative care, informal caregivers assume the primary responsibility in patient care and often face challenges such as increased physical and mental stress and declining health. In such cases, telemedicine interventions can provide support and improve their health outcomes. However, research findings regarding the use of telemedicine among informal caregivers are controversial, and the efficacy of telemedicine remains unclear.

OBJECTIVE

This study aimed to evaluate the impacts of telemedicine on the burden, anxiety, depression, and quality of life of informal caregivers of patients in palliative care.

METHODS

A systematic literature search was conducted using the PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL Plus with Full Text, CBM, CNKI, WanFang, and VIP databases to identify relevant randomized controlled trials published from inception to March 2023. Two authors independently screened the studies and extracted the relevant information. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Intervention effects were estimated and sensitivity analysis was conducted using Review Manager 5.4, whereas 95% prediction intervals (PIs) were calculated using R (version 4.3.2) and RStudio.

RESULTS

A total of 9 randomized controlled trials were included in this study. The meta-analysis indicated that telemedicine has reduced the caregiving burden (standardized mean differences [SMD] -0.49, 95% CI -0.72 to -0.27; P<.001; 95% PI -0.86 to -0.13) and anxiety (SMD -0.23, 95% CI -0.40 to -0.06; P=.009; 95% PI -0.98 to 0.39) of informal caregivers; however, it did not affect depression (SMD -0.21, 95% CI -0.47 to 0.05; P=.11; 95% PI -0.94 to 0.51) or quality of life (SMD 0.35, 95% CI -0.20 to 0.89; P=.21; 95% PI -2.15 to 2.85).

CONCLUSIONS

Although telemedicine can alleviate the caregiving burden and anxiety of informal caregivers, it does not significantly reduce depression or improve their quality of life. Further high-quality, large-sample studies are needed to validate the effects of telemedicine. Furthermore, personalized intervention programs based on theoretical foundations are required to support caregivers.

摘要

背景

远程医疗技术是一个快速发展的领域，在改善医疗服务方面具有巨大潜力。在姑息治疗中，非正式照护者承担着患者护理的主要责任，他们经常面临着增加的身心压力和健康状况下降等挑战。在这种情况下，远程医疗干预可以提供支持并改善他们的健康结果。然而，关于非正式照护者使用远程医疗的研究结果存在争议，远程医疗的疗效仍不清楚。

目的

本研究旨在评估远程医疗对姑息治疗中患者非正式照护者的负担、焦虑、抑郁和生活质量的影响。

方法

使用 PubMed、Embase、Web of Science、CENTRAL、PsycINFO、CINAHL Plus with Full Text、CBM、CNKI、WanFang 和 VIP 数据库进行系统文献检索，以确定从成立到 2023 年 3 月发表的相关随机对照试验。两位作者独立筛选研究并提取相关信息。使用 Cochrane 偏倚风险工具评估纳入研究的方法学质量。使用 Review Manager 5.4 估计干预效果，并进行敏感性分析，使用 R（版本 4.3.2）和 RStudio 计算 95%预测区间（PI）。

结果

本研究共纳入 9 项随机对照试验。荟萃分析表明，远程医疗降低了照护者的负担（标准化均数差[SMD]-0.49，95%置信区间[-0.72 至-0.27]；P<.001；95%PI[-0.86 至-0.13]）和焦虑（SMD-0.23，95%置信区间[-0.40 至-0.06]；P=.009；95%PI[-0.98 至 0.39]）；然而，它并没有影响抑郁（SMD-0.21，95%置信区间[-0.47 至 0.05]；P=.11；95%PI[-0.94 至 0.51]）或生活质量（SMD 0.35，95%置信区间[-0.20 至 0.89]；P=.21；95%PI[-2.15 至 2.85]）。