接纳与承诺疗法对癌症患者心理健康和生活质量影响的meta分析

doi:10.3969/j.issn.1004-583X.2024.02.001

摘要/Abstract

摘要：

目的系统评价接纳与承诺疗法(acceptance and commitment therapy,ACT)对癌症患者心理健康和生活质量的影响。方法检索建库至2022年11月在CBM、万方、知网、维普、PubMed、Cochrane Library、Web of Science、EMbase数据库发表的有关ACT对癌症患者心理健康和生活质量影响的随机对照试验。由2名研究者根据纳入及排除标准独立筛选文献、质量评价并提取数据,采用RevMan 5.4进行meta分析。结果共纳入14篇文献,1 063例癌症患者。Meta分析结果显示,ACT在改善癌症患者的焦虑[SMD=-1.04,95%CI (-1.19,-0.89),P<0.01]、抑郁情绪[SMD=-0.73,95%CI(-0.88,-0.59),P<0.01], 提升心理灵活性[MD=-2.17,95%CI (-2.77,-1.57),P<0.01]及生活质量[MD=5.27,95%CI(3.57,6.98),P<0.01]方面差异具有统计学意义。结论 ACT有助于缓解癌症患者的焦虑及抑郁情绪, 提升心理灵活性及生活质量, 对促进癌症患者的心理健康和生活质量具有积极作用。

关键词: 接纳与承诺疗法, 癌症, 心理护理, meta分析

Abstract:

Objective To systematically evaluate the effect of acceptance and commitment therapy (ACT) on the mental health and quality of life of cancer patients. Methods Randomized clinical trials (RCTs) reporting the influence of ACT on mental health and quality of life in cancer patients were searched in the CBM, WanFang, CNKI, VIP, PubMed, Cochrane Library, Web of Science and EMbase databases, and the retrieval time was from the time of building the database to November 2022. Literature screening based on inclusion and exclusion criteria, quality assessment and data extraction were performed by two investigators. A meta-analysis was conducted using Revman5.4 software. Results A total of 14 RCTs representing 1,063 cancer patients were enrolled. Meta-analysis results showed that ACT significantly improved anxiety (SMD=-1.04, 95%CI [-1.19, -0.89], P<0.01), depression (SMD=-0.73, 95%CI[ -0.88, -0.59], P<0.01), psychological flexibility (MD=-2.17, 95%CI[-2.77, -1.57], P<0.01) and quality of life in cancer patients (MD=5.27, 95%CI [3.57, 6.98], P<0.01). Conclusion ACT can relieve anxiety and depression, improve psychological flexibility and quality of life, and positively promoting physical and mental health of cancer patients.

Key words: acceptance and commitment therapy, cancer, psychological nursing, meta-analysis

中图分类号:

R473.73

龚财芳, 赵俊宇, 游川. 接纳与承诺疗法对癌症患者心理健康和生活质量影响的meta分析[J]. 临床荟萃, 2024, 39(2): 101-107.

Gong Caifang, Zhao Junyu, You Chuan. Effect of acceptance and commitment therapy on mental health and quality of life in cancer patients: A meta-analysis[J]. Clinical Focus, 2024, 39(2): 101-107.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2024.02.001

https://lchc.magtechjournal.com/CN/Y2024/V39/I2/101

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参考文献 37

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纳入文献	年份 (年)	癌症类型	样本量(例)		干预措施		干预时间及方式	结局指标	测量工具
纳入文献	年份 (年)	癌症类型	观察组	对照组	观察组	对照组	干预时间及方式	结局指标	测量工具
Shari等^[11]	2020	乳腺癌	30	30	ACT	常规护理	12周,1次/3周,1 h/次,面对面	①②③	HADS、AAQ-Ⅱ
Serfaty等^[12]	2018	各种类型	20	22	ACT+TC	TC	3月,8次/周,1 h/次,面对面	③④	HADS、FACT
Fernández-Rodríguez等^[14]	2020	各种类型	12	17	ACT	常规护理	3月,12次/周,90 min/次,面对面	①②③	HADS、AAQ-Ⅱ
González-Fernández等^[15]	2018	乳腺癌	12	23	ACT	常规护理	12次/周,90 min/次,面对面	①②③	HADS、AAQ-Ⅱ
Johns等^[16]	2019	乳腺癌	31	31	ACT	SE	6周, 1次/7d, 2 h/次,面对面	①②	GAD、PHQ
Li等^[17]	2022	肺癌	20	20	ACT	常规护理	1次/周,60~90 min/次,面对面+网络视频	①②④	GAD、PHQ
Mohabbat-Bahar等^[18]	2015	乳腺癌	15	15	ACT	常规护理	4周,2次/周,90 min/次,面对面	①②	BAI、BHI
周小帅^[19]	2020	乳腺癌	30	30	ACT	常规护理	2周,1次/2d,30 min/次,面对面	①②	SAS、SDS
姚晚侠等^[20]	2020	乳腺癌	140	140	ACT	常规护理	3月,1次/月,面对面+电话+微信	①②	SAS、SDS
潘虹等^[21]	2020	胰腺癌	37	42	ACT	常规护理	8周,6次/周,90 min/次,面对面	①②③	DASS、AAQ-Ⅱ
王婷婷等^[22]	2022	食管癌	50	50	ACT	常规护理	4周,面对面	①②③④	SAS、SDS、AAQ-Ⅱ、QLQ-C30
胡迎冬等^[23]	2016	乳腺癌	41	39	ACT	常规护理	2周,1次/2d,30~40 min/次,面对面	①②④	SAS、SDS、FACT
许湘华等^[24]	2019	喉癌	24	24	ACT	常规护理	术前1 d-术后5 d,面对面	③④	AAQ-Ⅱ、FACT
魏慧等^[25]	2020	直肠癌	59	59	ACT	常规护理	术前1 d-术后5 d,面对面	①②	HADS、AAQ-Ⅱ

纳入文献	年份 (年)	癌症类型	样本量(例)		干预措施		干预时间及方式	结局指标	测量工具
纳入文献	年份 (年)	癌症类型	观察组	对照组	观察组	对照组	干预时间及方式	结局指标	测量工具
Shari等^[11]	2020	乳腺癌	30	30	ACT	常规护理	12周,1次/3周,1 h/次,面对面	①②③	HADS、AAQ-Ⅱ
Serfaty等^[12]	2018	各种类型	20	22	ACT+TC	TC	3月,8次/周,1 h/次,面对面	③④	HADS、FACT
Fernández-Rodríguez等^[14]	2020	各种类型	12	17	ACT	常规护理	3月,12次/周,90 min/次,面对面	①②③	HADS、AAQ-Ⅱ
González-Fernández等^[15]	2018	乳腺癌	12	23	ACT	常规护理	12次/周,90 min/次,面对面	①②③	HADS、AAQ-Ⅱ
Johns等^[16]	2019	乳腺癌	31	31	ACT	SE	6周, 1次/7d, 2 h/次,面对面	①②	GAD、PHQ
Li等^[17]	2022	肺癌	20	20	ACT	常规护理	1次/周,60~90 min/次,面对面+网络视频	①②④	GAD、PHQ
Mohabbat-Bahar等^[18]	2015	乳腺癌	15	15	ACT	常规护理	4周,2次/周,90 min/次,面对面	①②	BAI、BHI
周小帅^[19]	2020	乳腺癌	30	30	ACT	常规护理	2周,1次/2d,30 min/次,面对面	①②	SAS、SDS
姚晚侠等^[20]	2020	乳腺癌	140	140	ACT	常规护理	3月,1次/月,面对面+电话+微信	①②	SAS、SDS
潘虹等^[21]	2020	胰腺癌	37	42	ACT	常规护理	8周,6次/周,90 min/次,面对面	①②③	DASS、AAQ-Ⅱ
王婷婷等^[22]	2022	食管癌	50	50	ACT	常规护理	4周,面对面	①②③④	SAS、SDS、AAQ-Ⅱ、QLQ-C30
胡迎冬等^[23]	2016	乳腺癌	41	39	ACT	常规护理	2周,1次/2d,30~40 min/次,面对面	①②④	SAS、SDS、FACT
许湘华等^[24]	2019	喉癌	24	24	ACT	常规护理	术前1 d-术后5 d,面对面	③④	AAQ-Ⅱ、FACT
魏慧等^[25]	2020	直肠癌	59	59	ACT	常规护理	术前1 d-术后5 d,面对面	①②	HADS、AAQ-Ⅱ

结局指标	纳入研究	异质性		效应模型	Meta分析结果
结局指标	纳入研究	P值	I²(%)	效应模型	SMD/MD	95%CI	Z值	P值
焦虑评分	11	0.36	9	固定	-0.99^*	[-1.14,-0.85]	13.62	<0.01
抑郁评分	10	0.29	16	固定	-0.68^*	[-0.83,-0.54]	9.42	<0.01
心理灵活性	6	0.95	0	固定	-2.17^#	[-2.77,-1.57]	7.11	<0.01
生活质量	4	0.10	49	固定	0.70^*	[0.43,0.97]	5.10	<0.01

结局指标	纳入研究	异质性		效应模型	Meta分析结果
结局指标	纳入研究	P值	I²(%)	效应模型	SMD/MD	95%CI	Z值	P值
焦虑评分	11	0.36	9	固定	-0.99^*	[-1.14,-0.85]	13.62	<0.01
抑郁评分	10	0.29	16	固定	-0.68^*	[-0.83,-0.54]	9.42	<0.01
心理灵活性	6	0.95	0	固定	-2.17^#	[-2.77,-1.57]	7.11	<0.01
生活质量	4	0.10	49	固定	0.70^*	[0.43,0.97]	5.10	<0.01