数字心理干预对癌症患者的心理困扰和生活质量是否有效？系统回顾和网络荟萃分析

IF 13.7 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review Pub Date : 2024-11-26 DOI:10.1016/j.cpr.2024.102520

Tao Zhang , Zhihong Ren , Claire Elizabeth Wakefield , Bryant Pui Hung Hui , Tatsuo Akechi , Congrong Shi , Xiayu Du , Wenke Chen , Lizu Lai , Chunxiao Zhao , Ying Li , Yubu Zhou

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引用次数: 0

摘要

许多癌症患者在癌症治疗期间或之后经历心理困扰和/或生活质量差，然而他们在获得心理支持方面面临多重障碍。数字心理干预是解决这些障碍的一种有希望的方法，但其相对有效性仍不确定。方法检索自成立至2024年7月的随机对照试验（rct）数据库。在本研究中，主要结局是心理困扰和生活质量，次要结局是抑郁、焦虑、失眠、疲劳和对癌症复发的恐惧。结果共纳入136项随机对照试验，共23154名受试者。在这些干预措施中，与非主动控制相比，三种类型的干预措施——数字化交付的认知行为治疗（CBT）、健康教育和虚拟现实治疗（VRT）——显示出心理困扰的显著减少。与非主动对照组相比，数字CBT、叙事干预和VRT显著改善了生活质量。对于抑郁症，数字CBT和VRT均优于非积极对照组。在焦虑方面，CBT、心理教育和VRT的表现优于非积极对照组。在疲劳方面，CBT、心理教育、VRT和多组分干预均比非积极对照组显示出更高的疗效。然而，与非主动对照相比，只有CBT在缓解失眠方面表现出显著的优越性。同样，与非主动控制条件相比，只有基于正念的干预显著降低了对癌症复发的恐惧。结论数字CBT和VRT是减少癌症患者心理困扰和提高生活质量的有效选择；进一步开展涉及不同人群的高质量随机对照试验是验证这些发现的必要条件。

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Are digital psychological interventions for psychological distress and quality of life in cancer patients effective? A systematic review and network meta-analysis

Background

Many cancer patients experience psychological distress and/or poor quality of life during or after their cancer treatment, yet they face multiple barriers to accessing psychological support. Digital psychological interventions represent a promising approach for addressing these barriers, however their comparative effectiveness remains uncertain.

Methods

Nine databases were searched for randomized controlled trials (RCTs) from inception to July 2024. The primary outcomes were psychological distress and quality of life, and the secondary outcomes were measures of depression, anxiety, insomnia, fatigue, and fear of cancer recurrence in this study.

Results

One hundred and thirty-six RCTs with 23,154 participants were identified. Of these interventions, three types—digitally-delivered cognitive behavioral therapy (CBT), health education, and virtual reality therapy (VRT)—demonstrated significant reductions in psychological distress compared to non-active controls. Digital CBT, narrative interventions, and VRT significantly improved quality of life compared to non-active controls. For depression, both digital CBT and VRT were superior to the non-active control group. Regarding anxiety, CBT, psychoeducation, and VRT outperformed the non-active control group. In terms of fatigue, CBT, psychoeducation, VRT, and multi-component interventions all showed enhanced efficacy compared to the non-active control group. However, only CBT exhibited significantly superior effectiveness in alleviating insomnia compared to non-active controls. Similarly, only mindfulness-based interventions significantly reduced fear of cancer recurrence compared to the non-active control condition.

Conclusions

Our results suggest that digital CBT and VRT are highly promising options for reducing psychological distress and enhancing the quality of life among cancer patients; further high-quality randomized controlled trials involving diverse populations are essential to validate these findings.

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来源期刊

Clinical Psychology Review PSYCHOLOGY, CLINICAL-

CiteScore

23.10

自引率

1.60%

发文量

期刊介绍： Clinical Psychology Review serves as a platform for substantial reviews addressing pertinent topics in clinical psychology. Encompassing a spectrum of issues, from psychopathology to behavior therapy, cognition to cognitive therapies, behavioral medicine to community mental health, assessment, and child development, the journal seeks cutting-edge papers that significantly contribute to advancing the science and/or practice of clinical psychology. While maintaining a primary focus on topics directly related to clinical psychology, the journal occasionally features reviews on psychophysiology, learning therapy, experimental psychopathology, and social psychology, provided they demonstrate a clear connection to research or practice in clinical psychology. Integrative literature reviews and summaries of innovative ongoing clinical research programs find a place within its pages. However, reports on individual research studies and theoretical treatises or clinical guides lacking an empirical base are deemed inappropriate for publication.