背景:癌症已经成为一个相当大的全球健康问题,对发病率和死亡率都有很大贡献。认识到迫切需要提高癌症患者的整体健康和生活质量(QOL),越来越多的研究人员已经开始在肿瘤学中使用基于在线正念的干预措施(MBIs).然而,这些干预措施的有效性和最佳实施方法仍然未知.
目的:本研究评估在线MBI的有效性,包括基于应用程序和基于网站的MBI,针对癌症患者,并提供有关这些干预措施在现实环境中的潜在实施和可持续性的见解。
方法:在8个电子数据库中进行搜索,包括Cochrane图书馆,WebofScience,PubMed,Embase,SinoMed,CINAHL完成,Scopus,和PsycINFO,直到2022年12月30日。纳入涉及年龄≥18岁的癌症患者的随机对照试验,并使用基于应用程序和基于网站的MBI与标准治疗相比。非随机研究,针对卫生专业人员或护理人员的干预措施,缺乏足够数据的研究被排除在外.两位独立作者筛选了文章,使用标准化表格提取数据,并使用Cochrane偏差风险评估工具评估研究中的偏差风险。使用ReviewManager(5.4版;CochraneCollaboration)和R(R统计计算基金会)中的meta包进行Meta分析。标准化平均差异(SMD)用于确定干预措施的效果。TheReach,有效性,收养,实施,和维护框架用于评估这些干预措施在现实环境中的潜在实施和可持续性。
结果:在筛选的4349篇文章中,包括15(0.34%)。总人口包括1613名参与者,其中870人(53.9%)处于实验条件,743人(46.1%)处于对照条件。Meta分析结果显示,与对照组相比,生活质量(SMD0.37,95%CI0.18-0.57;P<.001),睡眠(SMD-0.36,95%CI-0.71至-0.01;P=0.04),焦虑(SMD-0.48,95%CI-0.75至-0.20;P<.001),抑郁症(SMD-0.36,95%CI-0.61至-0.11;P=0.005),遇险(SMD-0.50,95%CI-0.75至-0.26;P<.001),干预后,基于应用和网站的MBIs组的癌症患者的感知压力(SMD-0.89,95%CI-1.33至-0.45;P=.003)显着减轻。然而,对癌症复发的恐惧(SMD-0.30,95%CI-1.04~0.44;P=.39)和创伤后生长(SMD0.08,95%CI-0.26~0.42;P=.66)无显著差异.大多数干预措施是多组分的,基于网站的健康自我管理计划,广泛用于国际和多语种癌症患者。
结论:基于应用程序和网站的MBI显示出改善癌症患者心理健康和生活质量的希望。需要进一步的研究来优化和定制这些针对个人身体和精神症状的干预措施。
背景:PROSPEROCRD42022382219;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=382219。
BACKGROUND: Cancer has emerged as a considerable global health concern, contributing substantially to both morbidity and mortality. Recognizing the urgent need to enhance the overall well-being and quality of life (QOL) of cancer patients, a growing number of researchers have started using online mindfulness-based interventions (MBIs) in oncology. However, the effectiveness and optimal implementation methods of these interventions remain unknown.
OBJECTIVE: This study evaluates the effectiveness of online MBIs, encompassing both app- and website-based MBIs, for patients with cancer and provides insights into the potential implementation and sustainability of these interventions in real-world settings.
METHODS: Searches were conducted across 8 electronic databases, including the Cochrane Library, Web of Science, PubMed, Embase, SinoMed, CINAHL Complete, Scopus, and PsycINFO, until December 30, 2022. Randomized controlled trials involving cancer patients aged ≥18 years and using app- and website-based MBIs compared to standard care were included. Nonrandomized studies, interventions targeting health professionals or caregivers, and studies lacking sufficient data were excluded. Two independent authors screened articles, extracted data using standardized forms, and assessed the risk of bias in the studies using the Cochrane Bias Risk Assessment Tool. Meta-analyses were performed using Review Manager (version 5.4; The Cochrane Collaboration) and the meta package in R (R Foundation for Statistical Computing). Standardized mean differences (SMDs) were used to determine the effects of interventions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to assess the potential implementation and sustainability of these interventions in real-world settings.
RESULTS: Among 4349 articles screened, 15 (0.34%) were included. The total population comprised 1613 participants, of which 870 (53.9%) were in the experimental conditions and 743 (46.1%) were in the control conditions. The results of the meta-analysis showed that compared with the control group, the QOL (SMD 0.37, 95% CI 0.18-0.57; P<.001), sleep (SMD -0.36, 95% CI -0.71 to -0.01; P=.04), anxiety (SMD -0.48, 95% CI -0.75 to -0.20; P<.001), depression (SMD -0.36, 95% CI -0.61 to -0.11; P=.005), distress (SMD -0.50, 95% CI -0.75 to -0.26; P<.001), and perceived stress (SMD -0.89, 95% CI -1.33 to -0.45; P=.003) of the app- and website-based MBIs group in patients with cancer was significantly alleviated after the intervention. However, no significant differences were found in the fear of cancer recurrence (SMD -0.30, 95% CI -1.04 to 0.44; P=.39) and posttraumatic growth (SMD 0.08, 95% CI -0.26 to 0.42; P=.66). Most interventions were multicomponent, website-based health self-management programs, widely used by international and multilingual patients with cancer.
CONCLUSIONS: App- and website-based MBIs show promise for improving mental health and QOL outcomes in patients with cancer, and further research is needed to optimize and customize these interventions for individual physical and mental symptoms.
BACKGROUND: PROSPERO CRD42022382219; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382219.