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对癌症相关疲劳的自我管理支持

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2024-12-22 17:15

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Abstract

Objectives

To describe and examine the theories, components, and effectiveness of self-management support interventions for individuals experiencing cancer-related fatigue.

Methods

A systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement. CINAHL, PubMed, Cochrane CENTRAL, and EMBASE were searched (from inception to June 2021) for randomised controlled trials examining self-management support interventions for managing cancer-related fatigue. Data were screened, extracted, and appraised by two authors. Data extraction was guided by the Self-management Support Taxonomy (i.e., a modified version of the Practical Reviews in Self-Management Support Taxonomy tailored to cancer). The Revised Cochrane Risk of Bias tool was used for study appraisal. A critical narrative synthesis was conducted.

Results

Fifty-one papers representing 50 different studies (n= 7,383) were identified. Most interventions were delivered post-treatment (40%) using in-person (i.e., ‘face-to-face’) encounters (40%), and were facilitated by health professionals (62%). A range of intervention approaches and self-management support strategies were used across studies. The average number of Self-management Support Taxonomy components used across studies was 6.1 (of 14). Thirty-one studies (62%) described a specific behaviour change theory to guide their self-management support intervention development. Twenty-nine studies (n=29/50; 58%) reported a positive intervention effect for fatigue immediately post-intervention. Of these 29 studies, 10 (34%) reported at least one sustained positive effect on fatigue over follow-up periods between two and 12 months.

Conclusions

Self-management support that is delivered after cancer treatment, facilitated by health professionals, and incorporating at least one in-person contact appears to produce the most favourable fatigue and behavioural outcomes. However, further work is needed to better understand how individual self-management support strategies and the application of a behavioural theory influence behaviour change. Program developers should guide self-management support with a behavioural theory, and describe their theory application in intervention development, implementation, and evaluation; ensure facilitators receive adequate support training; and seek the delivery preferences of cancer survivors. Future research should incorporate adequate follow-up to sufficiently evaluate the impact of programs on cancer-related fatigue and associated self-management behaviours. Findings from this review are relevant to all healthcare professionals, but are of most relevance to nurses as the largest cancer care workforce with a key role in delivering self-management support.

摘要翻译（仅供参考）

目标

描述和检查自我管理支持干预对经历癌症相关疲劳的个人的理论、组成部分和有效性。

方法

根据系统评价和元分析 2020 声明的首选报告项目报告了系统评价。对 CINAHL、PubMed、Cochrane CENTRAL 和 EMBASE 进行了搜索（从成立到 2021 年 6 月），以寻找用于管理癌症相关疲劳的自我管理支持干预措施的随机对照试验。数据由两位作者筛选、提取和评估。数据提取由自我管理支持分类法（即针对癌症的自我管理支持分类法实用评论的修改版）指导。修订后的 Cochrane 偏倚风险工具用于研究评估。进行了批判性的叙事综合。

结果

确定了代表 50 项不同研究的 51 篇论文（n = 7,383）。大多数干预措施是在治疗后（40%）通过面对面（即“面对面”）接触（40%）进行的，并由卫生专业人员（62%）协助。在研究中使用了一系列干预方法和自我管理支持策略。研究中使用的自我管理支持分类组件的平均数量为 6.1（共 14 个）。31 项研究 (62%) 描述了一种特定的行为改变理论来指导他们的自我管理支持干预的发展。29 项研究 (n=29/50; 58%) 报告了干预后立即对疲劳产生积极的干预效果。在这 29 项研究中，10 项 (34%) 报告了在 2 至 12 个月的随访期间对疲劳至少有一项持续的积极影响。

结论

癌症治疗后提供的自我管理支持，由卫生专业人员协助，并结合至少一次面对面的接触，似乎会产生最有利的疲劳和行为结果。然而，需要进一步的工作来更好地理解个人自我管理支持策略和行为理论的应用如何影响行为改变。项目开发人员应以行为理论指导自我管理支持，并描述其理论在干预开发、实施和评估中的应用；确保促进者接受足够的支持培训；并寻求癌症幸存者的分娩偏好。未来的研究应纳入充分的后续行动，以充分评估计划对癌症相关疲劳和相关自我管理行为的影响。本次审查的结果与所有医疗保健专业人员相关，但与护士最相关，因为护士是最大的癌症护理人员，在提供自我管理支持方面发挥着关键作用。

原文链接：

https://doi.org/10.1016/j.ijnurstu.2022.104206

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