Yang Cuiying, Shen Bin, Liu Jianjiang, Zhu Haiyan, Xu Wenli
Shaoxing People's Hospital, Shaoxing, 312000, Zhejiang, China.
Department of Radiotherapy, Shaoxing People's Hospital, Shaoxing, 312000, Zhejiang, China.
Support Care Cancer. 2024 Dec 30;33(1):61. doi: 10.1007/s00520-024-09125-7.
This study explores the impact of family dignity interventions (FDI) on palliative patients and their family caregivers through a systematic review and meta-analysis of randomized controlled trials (RCTs).
A systematic search was conducted in PubMed, Embase, and Cochrane databases for RCTs related to family-centered dignity interventions, with the search period extending from the inception of the databases up to July 2024. Statistical analyses were conducted using standardized mean difference (SMD) as the effect size with Stata 17.0 software for analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was employed to assess the certainty of evidence.
A total of 7 RCTs involving 556 pairs of palliative patients and their caregivers were included. Compared to the control group, palliative patients who received FDI demonstrated greater improvements in dignity (SMD, - 0.27; 95% confidence interval (CI), - 0.43; - 0.10), hope (SMD, 0.50; 95% CI, 0.24; 0.75), sense of meaning (SMD, 0.39; 95% CI, 0.18; 0.75), and spiritual well-being (SMD, 0.43; 95% CI, 0.24; 0.61). Concurrently, their family caregivers experienced more significant reductions in anxiety (SMD, - 0.61; 95% CI, - 0.92; - 0.30), depression (SMD, - 0.52; 95% CI, - 0.69; - 0.34), and anticipatory grief (SMD, - 0.71; 95% CI, - 1.12; - 0.31). Subgroup analysis indicated that the benefits gained by palliative patients disappeared 2 months after the intervention, whereas the benefits for their family caregivers persisted 2 months after the intervention.
Current low-quality evidence suggests that FDI may have short-term positive effects on the psycho-spiritual well-being of palliative care patients and reduce psychological distress in their family caregivers. Future research should focus on conducting high-quality RCTs to assess the dose-response effect of FDI on the families of palliative care patients, providing evidence to optimize intervention strategies.
本研究通过对随机对照试验（RCT）进行系统评价和荟萃分析，探讨家庭尊严干预（FDI）对姑息治疗患者及其家庭照顾者的影响。
在PubMed、Embase和Cochrane数据库中进行系统检索，查找与以家庭为中心的尊严干预相关的RCT，检索期从数据库建立至2024年7月。采用标准化均数差（SMD）作为效应量，使用Stata 17.0软件进行统计分析，并采用推荐分级评估、制定和评价（GRADE）方法评估证据的确定性。
共纳入7项RCT，涉及556对姑息治疗患者及其照顾者。与对照组相比，接受FDI的姑息治疗患者在尊严（SMD，-0.27；95%置信区间（CI），-0.43；-0.10）、希望（SMD，0.50；95%CI，0.24；0.75）、意义感（SMD，0.39；95%CI，0.18；0.75）和精神幸福感（SMD，0.43；95%CI，0.24；0.61）方面有更大改善。同时，他们的家庭照顾者在焦虑（SMD，-0.61；95%CI，-0.92；-0.30）、抑郁（SMD，-0.52；95%CI，-0.69；-0.34）和预期性悲伤（SMD，-0.71；95%CI，-1.12；-0.31）方面有更显著的减轻。亚组分析表明，姑息治疗患者获得的益处在干预后2个月消失，而其家庭照顾者的益处则在干预后2个月持续存在。
目前的低质量证据表明，FDI可能对姑息治疗患者的心理精神幸福感有短期积极影响，并减轻其家庭照顾者 的心理困扰。未来的研究应侧重于开展高质量的RCT，以评估FDI对姑息治疗患者家庭的剂量反应效应，为优化干预策略提供证据。
