在整个癌症护理连续体中，护士主导的干预对提高结直肠癌管理中患者相关结果的影响：一项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 : 2025-04-28 DOI:10.1016/j.ijnurstu.2025.105100

Yitong Han, Yujie Han, Wenshan Huang, Yantong Liu, Ziqi Wang, Wei Zhao, Wei Zhang

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引用次数: 0

摘要

结直肠癌在全球发病率中排名第三，在全球癌症相关死亡率中排名第二。尽管在整个护理连续体中持续存在挑战，但护士在通过量身定制的干预措施优化患者结果方面发挥着关键作用。然而，关于临床疗效和护士主导的干预措施的最佳交付的有力证据仍然有限。目的描述参与者的健康问题和护士主导的干预措施，并总结这些干预措施在从结直肠癌筛查到生存的整个过程中的效果。方法检索Web of Science、Cochrane图书馆、护理与相关健康文献累积索引、EMBASE、PubMed、Scopus、中国国家知识基础设施和万方数据等8个数据库，检索时间从建库到2024年5月。此外，还对纳入研究的参考文献表进行了检查。在奥马哈系统的基础上，应用内容分析来识别问题和干预措施。采用meta分析和描述性分析。根据研究设计、治疗史和干预方式进行亚组分析。结果28项研究确定了护士主导干预的问题和类型。在心理社会、生理和健康相关行为领域有13个问题。护士主导的干预措施包括教学、指导和咨询；病例管理;还有治疗和程序。护士主导的干预提高了结肠镜检查和粪便隐血检查的筛查率(优势比[OR] = 2.51；95%置信区间[CI]: 2.16 ~ 2.92；p & lt;0.001;或= 6.14；95% CI: 1.93 ~ 19.47；p = 0.002)，肠道准备是否充分(OR = 1.69；95% CI: 1.40 ~ 2.03；p & lt;0.001)，造口自我效能感(标准化平均差[SMD] = 2.48；95% CI: 0.71 ~ 4.25；p = 0.006)，生活质量(SMD = 0.72；95% CI: 0.21 ~ 1.22；p = 0.005)，降低了造口并发症的发生率(OR = 0.28；95% CI: 0.18 ~ 0.42；p & lt;0.001)，焦虑(SMD = - 1.19；95% CI:−1.40 ~−0.99；p & lt;0.001)，抑郁(SMD = - 1.00；95% CI:−1.20 ~−0.79；p & lt;0.001)。然而，护士主导的干预措施在减少痛苦和解决未满足的支持性护理需求方面是无效的。结论以护士为主导的干预措施可减少造口并发症、焦虑和抑郁，提高结直肠癌筛查率、肠准备充分性、造口自我效能和生活质量。然而，未来需要严格的研究来验证它们的效果并为更广泛的实施提供信息。RegistrationPROSPERO （CRD42024505730）于2024年2月18日注册。

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Effects of nurse-led interventions on enhancing patient-related outcomes in colorectal cancer management throughout the cancer care continuum: A systematic review and meta-analysis

Background

Colorectal cancer ranks third in global incidence and second in cancer-related mortality worldwide. Despite persistent challenges across the care continuum, nurses play a pivotal role in optimizing patient outcomes through tailored interventions. However, robust evidence on the clinical efficacy and optimal delivery of nurse-led interventions remains limited.

Objective

To describe the health problems of the participants and nurse-led interventions in accordance with the Omaha System and summarize evidence on the effects of these interventions throughout the continuum from colorectal cancer screening to survivorship.

Methods

Eight databases, namely, Web of Science, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, PubMed, Scopus, China National Knowledge Infrastructure and Wanfang Data, were searched from their inception to May 2024. Additionally, the reference lists of the included studies were examined. Content analysis was applied to identify problems and interventions based on the Omaha System. Meta-analysis and descriptive analysis were adopted. Subgroup analyses were conducted on the basis of the study design, treatment history and mode of intervention delivery.

Results

Twenty-eight studies identified problems and types of nurse-led interventions. There were 13 problems in the psychosocial, physiological and health-related behaviors domains. The nurse-led interventions included teaching, guidance and counseling; case management; and treatments and procedures. Nurse-led interventions improved screening rates for colonoscopy and fecal occult blood testing (odds ratio [OR] = 2.51; 95 % confidence interval [CI]: 2.16 to 2.92; p < 0.001; OR = 6.14; 95 % CI: 1.93 to 19.47; p = 0.002), the adequacy of bowel preparation (OR = 1.69; 95 % CI: 1.40 to 2.03; p < 0.001), stoma self-efficacy (standardized mean difference [SMD] = 2.48; 95 % CI: 0.71 to 4.25; p = 0.006), and quality of life (SMD = 0.72; 95 % CI: 0.21 to 1.22; p = 0.005), and reduced the incidence of stoma complications (OR = 0.28; 95 % CI: 0.18 to 0.42; p < 0.001), anxiety (SMD = − 1.19; 95 % CI: − 1.40 to − 0.99; p < 0.001), and depression (SMD = − 1.00; 95 % CI: − 1.20 to − 0.79; p < 0.001). However, nurse-led interventions were ineffective in reducing distress and addressing unmet supportive care needs.

Conclusion

Nurse-led interventions can reduce stoma complications, anxiety and depression and increase the screening rate for colorectal cancer, the adequacy of bowel preparation, stoma self-efficiency and quality of life. Nevertheless, future rigorous research is needed to validate their effects and inform wider implementation.

Registration

PROSPERO (CRD42024505730) registered on February 18, 2024.

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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).