John Defty, Richard Wagland, Joanne Turnbull, Alison Richardson
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引用次数: 0
摘要
背景：癌症及其治疗的并发症可能危及生命，扰乱癌症治疗并对健康相关的生活质量产生负面影响。虽然我们了解人们在癌症诊断前如何评估症状，但人们在癌症治疗期间如何决定寻求并发症的帮助却知之甚少。目的：描述患者和非正式护理人员如何评估暗示癌症及其治疗并发症的症状，并决定是否寻求（或不寻求）紧急护理的帮助。方法：系统综述和定性综合。采用定性方法检索了自2000年以来发表的6个电子数据库（ASSIA、CINAHL、Embase、MEDLINE、PsycInfo和Web of Science）（最后一次检索是在2024年10月11日）。进行了补充搜索和聚类搜索。根据“评估提示”标准的应用，确定了7120条记录，并纳入了22篇论文（代表300多名癌症患者的账户）。采用溯因分析对数据进行综合。研究结果：开发了一个概念图，以阐明五种分析结构如何相互作用并影响检测、解释和应对并发症的“患者工作”。研究结果表明，对症状的评估是反复进行的，并根据治疗前通过并发症经历以及接触紧急护理后形成的知识、技能和观念来进行评估。结论：这是第一个关于患者和非正式护理人员如何决定癌症相关并发症的综述。调查结果表明，应对并发症的准备工作应被视为一个过程（而不是一个事件），而不良的服务体验会导致寻求帮助的延迟，并有可能造成本可避免的伤害。普洛斯彼罗注册号：CRD42023422401。
Symptom appraisal and help-seeking for complications of cancer and its treatment: a systematic review and qualitative synthesis.
Background: Complications of cancer and its treatment can be life-threatening, disrupt cancer treatment and negatively impact health-related quality of life. While we understand how people appraise symptoms prior to a cancer diagnosis, little is known about how people decide to seek help for complications during cancer treatment.
Aim: Characterise how patients and informal caregivers appraise symptoms suggestive of, and decide whether to seek help from urgent and emergency care (or not) for, complications of cancer and its treatment.
Methods: Systematic review and qualitative synthesis. Six electronic databases (ASSIA, CINAHL, Embase, MEDLINE, PsycInfo and Web of Science) were searched for papers using qualitative methods published since 2000 (last search performed on 11 October 2024). Supplementary and cluster searches were performed. 7120 records were identified and 22 papers (representing accounts of over 300 people with cancer) were included following the application of the 'appraisal prompts' criteria. Data were synthesised using abductive analysis.
Findings: A conceptual map was developed to articulate how five analytic constructs interact and influence the 'patient work' of detecting, interpreting and responding to complications. Findings show that appraising symptoms is iterative and informed by knowledge, skills and perceptions developed prior to treatment through experiences of complications, and following contact with urgent and emergency care.
Conclusion: This is the first review to characterise how patients and informal caregivers make decisions about cancer-related complications. Findings show preparation for complications should be treated as a process (rather than an event), and poor experiences of services contribute to delayed help-seeking and risk avoidable harm.
期刊介绍：
Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance.
We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication.
In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.
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