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管理癌症与有意义生活（CALM）疗法对改善癌症患者生活质量的影响：一项随机对照试验的荟萃分析

Managing Cancer and Living Meaningfully (CALM) Therapy for Improving the Quality of Life of Patients With Cancer: A Meta-Analysis of Randomised Controlled Trials.

作者信息

Gautama Made Satya Nugraha, Huang Tsai-Wei, Haryani Haryani, Khalish Gaviota, Liu An-I, Wibawa Yan Adi

机构信息

Department of Nursing, Faculty of Medicine, Universitas Pendidikan Ganesha in Bali, Singaraja, Indonesia.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

出版信息

J Clin Nurs. 2025 Nov;34(11):4590-4606. doi: 10.1111/jocn.17754. Epub 2025 Mar 24.

DOI:10.1111/jocn.17754
PMID:40125635
Abstract

BACKGROUND

Cancer patients, at both early and advanced stages, face complex bio-psycho-social-spiritual problems impacting their quality of life (QoL). Managing Cancer and Living Meaningfully (CALM) therapy is a psychotherapeutic approach that helps cancer patients find hope and meaning in life, thereby improving QoL.

AIM

This study aimed to critically assess the effects of CALM therapy on the QoL in cancer patients.

DESIGN

This was a systematic review and meta-analysis of randomised controlled trials (RCTs).

METHODS

The main outcome was QoL, and the secondary outcomes were anxiety, depression, spiritual well-being, fatigue and sleep quality. Five English databases (PubMed, Embase, Scopus, Cochrane Library and ProQuest) and one trial registry site (Clinicaltrial.gov) were searched from their inception until March 2024. The pooled effect sizes were calculated using random-effects models and expressed as standard mean difference (SMD) or weighted mean difference (WMD). Review Manager 5.4 was used for data analysis. A sensitivity analysis was done by excluding one trial at a time to check the consistency of the results on QoL. The study protocol was prospectively registered on PROSPERO (CRD42023398655).

RESULTS

Fifteen trials met the inclusion criteria for the systematic review and twelve for the meta-analysis, with a total of 1635 cancer patients. CALM therapy showed significant benefits on QoL (SMD = 1.97), spiritual well-being (WMD = 1.93) and sleep quality (SMD = -1.56) compared with usual care. It also reduced anxiety (SMD = -1.94), depression (SMD = -1.28) and fatigue (SMD = -5.86) significantly. The sensitivity analysis confirmed the stability of these results when each trial was removed one by one.

CONCLUSION

CALM therapy may improve QoL, spiritual well-being, sleep quality and relieve anxiety, depression and fatigue in cancer patients.

RELEVANCE TO CLINICAL PRACTICE

This therapy should be promoted clinically as a comprehensive psychotherapeutic approach in cancer care.

REGISTRATION

CRD42023398655.

摘要

背景

癌症患者，无论处于早期还是晚期，都面临着影响其生活质量（QoL）的复杂生物 - 心理 - 社会 - 精神问题。“管理癌症并活得有意义”（CALM）疗法是一种心理治疗方法，可帮助癌症患者在生活中找到希望和意义，从而提高生活质量。

目的

本研究旨在严格评估CALM疗法对癌症患者生活质量的影响。

设计

这是一项对随机对照试验（RCT）的系统评价和荟萃分析。

方法

主要结局是生活质量，次要结局是焦虑、抑郁、精神幸福感、疲劳和睡眠质量。检索了五个英文数据库（PubMed、Embase、Scopus、Cochrane图书馆和ProQuest）以及一个试验注册网站（Clinicaltrial.gov），从其创建到2024年3月。使用随机效应模型计算合并效应量，并表示为标准化均数差（SMD）或加权均数差（WMD）。使用Review Manager 5.4进行数据分析。通过一次排除一项试验进行敏感性分析，以检查生活质量结果的一致性。该研究方案已在PROSPERO（CRD42023398655）上进行前瞻性注册。

结果

15项试验符合系统评价的纳入标准，12项符合荟萃分析的纳入标准，共有1635名癌症患者。与常规护理相比，CALM疗法在生活质量（SMD = 1.97）、精神幸福感（WMD = 1.93）和睡眠质量（SMD = -1.56）方面显示出显著益处。它还显著降低了焦虑（SMD = -1.94）、抑郁（SMD = -1.28）和疲劳（SMD = -5.86）。敏感性分析证实，逐一剔除每项试验时这些结果的稳定性。

结论

CALM疗法可能改善癌症患者的生活质量、精神幸福感、睡眠质量，并缓解焦虑、抑郁和疲劳。

与临床实践的相关性

这种疗法应作为癌症护理中的一种综合心理治疗方法在临床上推广。

注册

CRD42023398655

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