Lin Lijun, Jin Ying, Feng Chunxiao, Zhu Kejia
College of Nursing, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Nursing, The second affiliated hospital of Zhejiang Chinese Medical University, Hangzhou, China.
PLoS One. 2025 Apr 16;20(4):e0321719. doi: 10.1371/journal.pone.0321719. eCollection 2025.
During cancer treatment, patients are faced with major changes in physical function, psychological challenges and decline in quality of life. Self-advocacy is a key tool for patients to cope with the challenges of treatment. By fostering self-advocacy, patients can effectively self-manage, enhancing their overall quality of life and treatment outcomes. Besides, a significant majority of cancer patients encounter barriers when attempting to articulate their healthcare needs and engage in treatment decision-making processes. It's important to identify obstacles in the process of self-advocacy. The aim of this meta-synthesis was to describe the patients' experience of self-advocacy, and identify the facilitators and barriers of self-advocacy for cancer patients.
The review used the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines guided reporting, and appraised the quality of each eligible study using the Critical Appraisal Skills Programme (CASP) checklist. A prospective review protocol was registered in the International Prospective Register of Systematic Reviews(no: CRD42023493926). A qualitative meta-synthesis was performed by searching eight electronic databases, including PubMed, Web of Science, Embase, Ovid MEDLINE, CINAHL, CNKI, Wanfang and SinoMed for studies meeting pre-defined eligibility criteria, from inception to November, 2023. Two reviewers independently undertook screening and review of articles, using the CASP checklist for evaluating qualitative research. The data were synthesised using Thomas and Harden's method of thematic and content analysis.
A total of 7 papers were included, and 24 research findings were distilled and integrated into three themes: benefits; challenges; external environmental support; and seven sub-themes: Gain confidence; improve self-management ability; Interaction and share; lack of awareness; obstacles; health system support and social support.
Cancer patients have different levels of self-advocacy ability, which is the result of the interaction between personal consciousness and family and social environment. Factors influencing self-initiative include patient gender, personality characteristics, support from friends and family, and support from the medical system. Therefore, medical staff should pay more attention to cancer patients with weak awareness of self-advocacy and poor enthusiasm and can use patient friend exchange meetings and entertainment interventions to improve patients 'level of self-advocacy. Future interventions should comprehensively consider the characteristics of cancer patients themselves and their external environment, and engage in multidisciplinary team cooperation.
在癌症治疗期间，患者面临身体功能的重大变化、心理挑战以及生活质量的下降。自我主张是患者应对治疗挑战的关键工具。通过培养自我主张，患者可以有效地进行自我管理，提高他们的整体生活质量和治疗效果。此外，绝大多数癌症患者在试图表达自己的医疗需求并参与治疗决策过程时会遇到障碍。识别自我主张过程中的障碍很重要。本元综合分析的目的是描述患者的自我主张经历，并识别癌症患者自我主张的促进因素和障碍。
本综述采用系统评价和Meta分析的首选报告项目（PRISMA）指南指导报告，并使用批判性评价技能计划（CASP）清单评估每项符合条件的研究的质量。一项前瞻性综述方案已在国际前瞻性系统评价注册库中注册（编号：CRD42023493926）。通过检索八个电子数据库进行定性元综合分析，这些数据库包括PubMed、Web of Science、Embase、Ovid MEDLINE、CINAHL、CNKI、万方和中国生物医学文献数据库，以查找从创刊到2023年11月符合预定义纳入标准的研究。两名评审员独立进行文章筛选和评审，使用CASP清单评估定性研究。数据采用托马斯和哈登的主题和内容分析方法进行综合。
共纳入7篇论文，24项研究结果被提炼并整合为三个主题：益处；挑战；外部环境支持；以及七个子主题：获得信心；提高自我管理能力；互动与分享；意识缺乏；障碍；卫生系统支持和社会支持。
癌症患者具有不同程度的自我主张能力，这是个人意识与家庭及社会环境相互作用的结果。影响自我主张的因素包括患者性别、性格特征、朋友和家人的支持以及医疗系统的支持。因此，医务人员应更加关注自我主张意识薄弱、积极性差的癌症患者，并可利用患者朋友交流会和娱乐干预措施来提高患者的自我主张水平。未来的干预措施应综合考虑癌症患者自身及其外部环境的特点，并进行多学科团队合作。
