心理干预对恶性肿瘤患者情绪困扰及生存质量影响的Meta分析

发布时间：2018-09-01 18:28

【摘要】：目的：为恶性肿瘤病人提供心理干预,对其因疾病本身引起的情绪困扰及相关因素导致的生活质量重大改变都具有可推测的意义及合理性。然而目前,与此相关的国内外研究存在一定分歧,为尝试解决争议,并更好地评价心理干预的效果,笔者利用循证医学系统评价的方法,综合1980至2015年间有关心理干预影响恶性肿瘤患者生存质量以及情绪困扰的中英文文献进行系统综述及meta分析,全面评价心理干预的效果,以期为临床干预的应用及疗效分析提供数据参考及科学依据。方法：根据Cochrane评价手册,利用计算机检索英文数据库Cochrane、Embase、 Ovid、CINAHL、Pub Med、Web of Science,中文数据库CNKI、CBM disc、VIP、 Sino Med、WanFang数据库,检索截止到2015年4月国内外公开发表的关于心理干预恶性肿瘤患者的随机对照试验,根据Cochrane手册提供的文献质量标准筛选文献,对符合既定纳入标准的文献进行量化的Meta分析。使用统一的文献信息表提取各种文献的原始数据,应用Revman5.0软件对数据进行Meta分析。结果：经过各种筛选后,本次研究共纳入41篇文献进入量性的Meta分析(中文12篇,英文29篇)。心理干预能够有效提高恶性肿瘤患者的生存质量(平均提高5.31个百分点,MD=5.31,95%CI (2.99,7.63), Z=4.49, P0.00001),降低恶性肿瘤患者的焦虑水平(平均降低10.75个百分点,MD=-10.75,95%CI(-15.59,-5.90), Z=4.35, P0.0001),降低恶性肿瘤患者的抑郁水平(平均降低9.85个百分点,MD=-9.85,95% CI (-11.35,-8.35), Z=12.86, P0.00001),以及整体情绪困扰水平(平均降低10.07个百分点,MD=-20.13 (2个T分),95% CI (-25.35,-14.91), Z=7.75, P0.00001);长期的心理干预对于提高恶性肿瘤患者的生存质量效果要优于短期心理干预(短期：MD=-0.63,95CI(-3.72,2.47),Z=0.40,P=0.69；长期：MD=7.93,95CI (3.75,12.12), Z=3.71, P=0.0002),短期的心理干预对于降低恶性肿瘤患者的焦虑水平效果要优于长期心理干预(短期：MD=-13.98,95% CI (-23.73,-4.23),1=2.81, P=0.005;长期:MD=-6.01, 95CI%(-9.07,-2.95), Z=3.85, P=0.0001),短期的心理干预对于降低恶性肿瘤患者的抑郁水平效果要优于长期心理干预(短期：MD=-13.10,95%CI (-16.99,-9.22),Z=6.61,P0.00001；长期：MD=-7.86,95CI%(-9.30,-6.42), Z=10.72,P0.00001),短期的心理干预对于降低恶性肿瘤患者的整体情绪困扰水平效果要优于长期心理干预(短期：MD=-29.32,95%CI (-38.76,-19.88), Z=6.09,P0.00001；长期：MD=-12.37, 95CI%(-16.24, -8.5), Z=6.27, P0.00001)。另外,住院心理干预对于提高恶性肿瘤患者生存质量的效果要优于门诊心理干预(住院：MD=8.78, 95CI%(4.74, 12.82), Z=4.26, P.0.001,门诊：MD=3.11, 95CI%(0.62, 5.60), Z=2.45, P=0.01),住院心理干预对于降低恶性肿瘤患者整体情绪困扰的效果优于门诊心理干预(住院：MD=-22.09, 95CI%(-26.99,-17.2),Z=2.36,P=0.02；门诊：MD=-16.23, 95CI%(-29.70, 2.76), Z=2.36,P=0.02)；团体心理治疗对于提高恶性肿瘤患者的生存质量的效果优于个人心理治疗(团体：MD=8.41, 95CI%(6.62, 10.20), Z=9.21, PO.0000;个人: MD=4.64, 95CI%(2.03, 7.25), Z=3.48, P=0.0005),个人心理治疗对于缓解恶性肿瘤患者的整体情绪困扰的效果优于团体治疗(团体：MD=-I6.32, 95CI%(-18.77,-4.81), 2=3.31, PO.00001; 个人: MD=-23.62, 95CI%(-29.59, -17.64), Z=7.75, P0.0001 )结论：综合中英文文献,心理干预能够有效提高恶性肿瘤患者的生存质量和降低他们的情绪困扰水平,但心理干预的效果受到干预时间、干预地点以及干预人员的影响。在本次meta分析的结果中显示,短期的心理干预对于缓解患者情绪困扰的效果优于提高其生存质量,而长期心理干预则有助于提高患者远期的生活质量；另外,本次meta分析提示,患者接受住院接受心理干预的效果(生存质量以及情绪困扰)要优于门诊部开展的心理干预；团体治疗在提高患者生存质量方面的效果要优于一对一的个人治疗,而一对一的个人治疗在缓解情绪困扰方面优于团体治疗；综上所述,我们建议患者接受短期住院式一对一的个人心理干预(急性期)配合长期的门诊团体心理干预(慢性期),这样对于提高他们的生存质量以及降低情绪困扰水平有更为明显的效果,同时可以节约医疗成本,适时、高效分配医疗资源,从而产生更高的医疗价值。
[Abstract]:Objective: To provide psychological intervention for patients with malignant tumors, which is of conjectural significance and rationality for their emotional distress caused by the disease itself and significant changes in quality of life caused by related factors. Results: Using the method of Evidence-based Medicine Systematic Assessment, the author made a systematic review and meta-analysis of the Chinese and English literatures on the influence of psychological intervention on the quality of life and emotional distress of patients with malignant tumors from 1980 to 2015, and comprehensively evaluated the effect of psychological intervention, in order to provide data reference and department for the application and effect analysis of clinical intervention. Methods: According to the Cochrane evaluation manual, the English databases Cochrane, Embase, Ovid, CINAHL, Pub Med, Web of Science, Chinese databases CNKI, CBM disc, VIP, Sino Med, Wang Fang were retrieved by computer. The randomized controlled trials on psychological intervention in malignant tumor patients published at home and abroad up to April 2015 were retrieved. According to the literature quality standard provided by Cochrane handbook, we screened the literatures and analyzed the literatures that met the established inclusion criteria quantitatively. The original data of various literatures were extracted from the unified literature information table, and the data were analyzed by Revman 5.0 software. Results: After various screening, 41 articles were included in this study. Meta-analysis (12 Chinese articles, 29 English articles). Psychological intervention can effectively improve the quality of life of patients with malignant tumors (average increase of 5.31 percentage points, MD = 5.31, 95% CI (2.99, 7.63), Z = 4.49, P 0.00001), reduce the anxiety level of patients with malignant tumors (average decrease of 10.75 percentage points, MD = - 10.75, 95% CI (- 15.59, - 5.90), Z = 4.35). Depression was lowered by 9.85 percentage points (MD = - 9.85, 95% CI (- 11.35, - 8.35), Z =12.86, P 0.00001), and overall emotional distress was lowered by 10.07 percentage points, MD = - 20.13 (2 T points), 95% CI (- 25.35, - 14.91), Z =7.75, P 0.00001) in patients with malignant tumors. The effect of short-term psychological intervention was better than short-term psychological intervention (short-term: MD = - 0.63,95CI (- 3.72,2.47), Z = 0.40, P = 0.69; long-term: MD = 7.93,95CI (3.75,12.12), Z = 3.71, P = 0.0002); short-term psychological intervention was better than long-term psychological intervention (short-term: MD = - 13.98, 95% CI (- 23.73, - 4). Long-term: MD = - 6.01, 95 CI% (- 9.07, - 2.95), Z = 3.85, P = 0.0001), short-term psychological intervention is better than long-term psychological intervention (short-term: MD = - 13.10, 95% CI (- 16.99, - 9.22), Z = 6.61, P 0.00001; long-term: MD = - 7.86, 95 CI% (- 9.30, - 6.42), Z = 10.72, P Psychological intervention is better than long-term psychological intervention (short-term: MD = - 29.32, 95% CI (- 38.76, - 19.88), Z = 6.09, P 0.00001; long-term: MD = - 12.37, 95 CI% (- 16.24, 8.5), Z = 6.27, P 0.00001). In addition, in-patient psychological intervention can improve the quality of life of patients with malignant tumors. To be better than outpatient psychological intervention (inpatient: MD = 8.78, 95 CI% (4.74, 12.82), Z = 4.26, P.0.001, outpatient: MD = 3.11, 95 CI% (0.62, 5.60), Z = 2.45, P = 0.01), inpatient psychological intervention for reducing overall emotional distress of malignant tumor patients is better than outpatient psychological intervention (inpatient: MD = - 22.09, 95 CI% (- 26.99, - 17.2), Z = 2.36, P = 0.02; MD = - 16.23, 95 CI% (- 29.70, 2.76), Z = 2.36, P = 0.02); group psychotherapy is superior to individual psychotherapy in improving the quality of life of patients with malignant tumors (group: MD = 8.41, 95 CI% (6.62, 10.20), Z = 9.21, PO.0000; individual: MD = 4.64, 95 CI% (2.03, 7.25), Z = 3.48, P = 0.0005); and individual psychotherapy is superior to individual psychotherapy in alleviating malignant tumors. The overall effect of emotional distress in cancer patients was better than that of group therapy (group: MD = - I6.32, 95 CI% (- 18.77, - 4.81), 2 = 3.31, PO.00001; individual: MD = - 23.62, 95 CI% (- 29.59, 17.64), Z = 7.75, P 0.0001). Conclusion: Combined with Chinese and English literature, psychological intervention can effectively improve the quality of life of cancer patients and reduce their emotional distress. The results of this meta-analysis show that short-term psychological intervention is more effective than long-term psychological intervention in alleviating patients'emotional distress and improving their quality of life. The meta-analysis suggested that the effect of psychological intervention (quality of life and emotional distress) on inpatients was better than that of outpatients; group therapy was better than one-to-one individual therapy in improving the quality of life of patients, and one-to-one individual therapy was better than group therapy in alleviating emotional distress. To sum up, we suggest that patients receive short-term one-to-one personal psychological intervention (acute phase) with long-term outpatient group psychological intervention (chronic phase), so as to improve their quality of life and reduce the level of emotional distress has a more obvious effect, while saving medical costs, timely and efficient distribution of medical care. Resources, resulting in higher medical value.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R273
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本文编号：2217997