行为激活对癌症患者心理困扰的影响：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 : 2024-12-18 DOI:10.1016/j.ijnurstu.2024.104983

Meng Wei , Azlina Yusuf , Caryn Chan Mei Hsien , Maziah Ahmad Marzuki

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引用次数: 0

摘要

背景：癌症是一种危及生命的疾病，对患者的心理健康有重大影响。行为激活是一种新兴的心理疗法，被认为对改善抑郁和焦虑很有效。然而，目前还没有评论总结它对癌症患者心理困扰的影响。目的：确定为癌症患者设计的行为激活研究，并检查对心理困扰的影响，包括抑郁和焦虑。设计：系统回顾和荟萃分析。方法：系统检索PubMed/MEDLINE、CINAHL、EMBASE、PsycINFO和Cochrane Library数据库，检索时间为建站至2024年4月6日。报告了行为激活对癌症患者心理困扰影响的随机对照试验。两位作者独立筛选了符合条件的研究，评估了研究质量，并提取了数据。使用Cochrane随机试验风险-偏倚工具第2版（RoB 2）评估偏倚风险。meta分析采用Review Manager 5.4进行，当meta分析不合适时采用叙述性综合。采用建议、评估、发展和评价分级（GRADE）系统评估证据的确定性。结果：本系统综述共纳入9项研究，共纳入1811名受试者。合并分析显示，行为激活可以改善抑郁症(SMD = -0.24, 95% CI -0.44 - -0.03, p = 0.020；中度证据质量)和焦虑(SMD = -0.56, 95% CI -1.01 - -0.10, p = 0.020；证据质量低)。这些效应在敏感性分析中是稳健的，并且在由于数据不足而没有汇总的研究中产生一致的结果。亚组分析表明，面对面给药和分组给药更有效，而不同剂量的效果尚不确定。此外，行为激活在不同随访期的影响尚未确定，对干预的最佳组成部分没有达成共识。结论：行为激活作为一种有效治疗癌症患者心理困扰的证据是有希望的。然而，应该指出的是，证据的质量是中等和低的，因此强调在应用这些发现时需要谨慎。为了探索哪些成分可能最有效地改善心理结果，更严格的研究设计和更详细的干预描述是必要的。注册：协议在PROSPERO上注册（注册号：CRD42024533171）。

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Effects of behavioural activation on psychological distress among people with cancer: A systematic review and meta-analysis

Background

Cancer is a life-threatening disease that can have a significant impact on patients' psychological well-being. Behavioural activation is an emerging psychological therapy that has been suggested effective in improving depression and anxiety. However, no review has yet summarised its effects on psychological distress among people with cancer.

Objective

To identify studies of behavioural activation designed for people with cancer and examine the effects on psychological distress, including depression and anxiety.

Design

Systematic review and meta-analysis.

Methods

A systematic search of PubMed/MEDLINE, CINAHL, EMBASE, PsycINFO, and the Cochrane Library was performed from the inception to 6 April 2024. Randomised controlled trials reporting on the effects of behavioural activation on psychological distress among cancer patients were included. Two authors independently screened the eligible studies, assessed the quality of studies, and extracted data. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). The meta-analysis was performed by Review Manager 5.4, and narrative synthesis was employed when the meta-analysis was inappropriate. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the certainty of the evidence.

Results

A total of nine studies were included in this systematic review, with 1811 participants. The pooled analysis showed that behavioural activation could improve depression (SMD = − 0.24, 95 % CI -0.44 - -0.03, p = 0.020; moderate quality of evidence), and anxiety (SMD = − 0.56, 95 % CI -1.01 - -0.10, p = 0.020; low quality of evidence) among people with cancer. The effects were robust in sensitivity analysis and yielded consistent results in studies that were not pooled due to insufficient data. Subgroup analyses suggested that face-to-face and group administration were more effective, whereas the effects of different dosages were uncertain. Besides, the effects of behavioural activation at different follow-up periods were not identified There was no consensus on the optimal components of intervention.

Conclusions

The evidence for behavioural activation as an effective treatment of psychological distress among people with cancer is promising. However, it should be noted that the quality of evidence was moderate and low, thus emphasising the need for caution when applying these findings. In order to explore which components may be most effective in improving psychological outcomes, more rigorous study designs and more detailed descriptions of interventions are necessary.

Registration

The protocol was registered on PROSPERO (Registration number: CRD42024533171).

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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).