有针对性的姑息关怀干预对晚期癌症患者非正式照护者的抑郁、生活质量和照护负担的影响：随机对照试验的系统回顾和荟萃分析。

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2024-09-06 DOI:10.1016/j.ijnurstu.2024.104895

Qianwen Yan , Chuanmei Zhu , Linna Li , Yunhuan Li , Yang Chen , Xiaolin Hu

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引用次数: 0

摘要

目的研究有针对性的姑息关怀干预措施对晚期癌症患者非正式照护者的抑郁、生活质量和照护者负担的影响，以及各种干预措施的后果：本研究对随机对照试验进行了全面回顾和荟萃分析：在 PubMed、Embase、CLNAHL、PsyclNFO、Cochrane、VIP、CNKI 和 WANFANG 八个数据库中进行了广泛的检索，检索时间从图书馆成立之初到 2024 年 5 月 4 日。两名审查员根据 PICOS 原则制定的资格标准独立筛选文章并提取数据。荟萃分析利用StataCorp（16.0版）进行，通过计算标准化均值差异（SMD）和95%置信区间（CI）来估计干预措施的影响。敏感性分析采用单向淘汰法进行。采用 Egger 检验法以及 Duval 和 Tweedie 修剪填充法来探讨潜在的发表偏倚。采用 Cochrane 偏倚风险工具评估纳入研究的方法学质量，并采用 GRADE 方法评估证据的总体质量：本研究汇总了 2007 年至 2023 年间发表的 16 项研究性研究（包括 2046 名非正式护理人员）。荟萃分析结果表明，有针对性的姑息关怀干预能显著改善抑郁状况（SMD = -0.74，95 % CI：[-1.25，-0.23]，P 结论：有针对性的姑息关怀干预能有效改善抑郁状况：有针对性的姑息关怀干预有效地改善了非正式照护者的抑郁状况和生活质量，但却未能明显减轻照护者的负担。为了更好地支持非正规照护者，干预者应该在综合考虑干预时间、干预形式和干预方法的基础上，采取个性化的策略。同时，为了提高姑息关怀服务的可及性，有效地将学术研究成果应用于临床实践，学者们还需要进一步的探索和努力：注册号：CRD42023475620。

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The effect of targeted palliative care interventions on depression, quality of life and caregiver burden in informal caregivers of advanced cancer patients: A systematic review and meta-analysis of randomized controlled trials

Objective

To investigate the efficacy of targeted palliative care interventions on depression, quality of life and caregiver burden in informal caregivers of advanced cancer patients, along with the consequences of various intervention types.

Design

This study performed a comprehensive review and a meta-analysis of randomized controlled trials.

Method

An extensive search was carried out across eight databases, namely, PubMed, Embase, CLNAHL, PsyclNFO, Cochrane, VIP, CNKI, and WANFANG, spanning from the inception of the library to May 4, 2024. Two examiners independently screened the articles and extracted the data according to the eligibility criteria formulated in accordance with the PICOS principles. The meta-analysis was conducted utilizing the StataCorp (version 16.0), estimating the impacts of the interventions through the computation of the standardized mean difference (SMD) and the 95 % confidence interval (CI). Sensitivity analysis was carried out using a one-way-out method. Egger's test and the Duval and Tweedie trim-and-fill methods were used to explore the potential publication bias. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of the included studies, and the overall quality of evidence was evaluated using the GRADE method.

Results

This study pooled 16 RCTs (including 2046 informal caregivers) that were published from 2007 to 2023. The meta-analysis results indicated that the targeted palliative care interventions significantly improved depression (SMD = − 0.74, 95 % CI: [− 1.25, − 0.23], P < 0.01) and quality of life (SMD = 0.63, 95 % CI: [0.08, 1.17], P = 0.03), though not in terms of caregiver burden (SMD = − 0.33, 95 % CI: [− 0.95, 0.29], P = 0.30) among informal caregivers of advanced cancer patients. Analysis of the subgroups revealed a correlation between short-term interventions, under three months, and the improvement of depression. Strategies focused solely on caregivers have proven effective in alleviating depression. Interventions utilizing offline methods have been shown to not only lower depression levels but also improve the quality of life for caregivers.

Conclusions

The targeted palliative care interventions effectively improved informal caregivers' depression and quality of life, yet they fail to markedly lessen the caregiver burden. To better support informal caregivers, interveners ought to adopt personalized strategies based on comprehensive consideration of the duration, format, and delivery methods of the interventions. Simultaneously, further exploration and effort from scholars are necessary to enhance the accessibility of palliative care services, and to effectively incorporate academic research findings into clinical practice.

Registration

CRD42023475620.

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).