接纳与承诺疗法对乳腺癌患者干预效果的Meta分析

doi:10.3761/j.issn.0254-1769.2022.09.007

摘要/Abstract

摘要：

目的系统评价接纳与承诺疗法对乳腺癌患者的干预效果。方法计算机检索Cochrane Library、Web of Science、PubMed、Embase、CINAHL、PsycInfo、中国知网、万方数据库、维普数据库、中国生物医学文献数据库中关于接纳与承诺疗法对乳腺癌患者干预效果的随机对照实验,检索时限为建库至2021年8月。由2名研究者根据纳入和排除标准对文献进行筛选、提取资料和方法学质量评价,运用Revman 5.4软件进行Meta分析。结果共纳入13篇随机对照研究,共1 061例患者。Meta分析结果显示,与常规护理相比,接纳与承诺疗法可减少乳腺癌患者的抑郁情绪[SMD=-1.15,95%CI（-1.48,-0.82）,P<0.001]、焦虑水平[SMD=-1.28,95%CI（-1.53,-1.04）,P<0.001],提升心理灵活性[MD=-12.26,95%CI（-15.02, -9.51）,P<0.001]及创伤后成长水平[MD=-12.48,95%CI（-13.55,-11.40）,P<0.001],增加患者疾病感知益处[MD=-8.77,95%CI（-10.79,-6.75）,P<0.001]。结论接纳与承诺疗法能够缓解乳腺癌患者的抑郁及焦虑情绪,提高心理灵活性及创伤后成长水平,增强疾病感知益处,对乳腺癌患者心理状态的改善起到积极作用。

关键词: 接纳与承诺疗法, 乳腺癌, 心理护理, Meta分析, 循证护理学

Abstract:

Objective To systematically evaluate the intervention effect of acceptance and commitment therapy on breast cancer patients. Methods A systematic search of databases, including the Cochrane Library, Web of Science, PubMed, Embase, CINAHL, PsycInfo, CNKI, WanFang Data and CBM, was carried out to collect randomized controlled trials on acceptance and commitment therapy on breast cancer patients from inception to August, 2021. There were 2 researchers who screened the literature according to inclusion and exclusion criteria, extracted data and evaluated the methodological quality. Meta-analysis was conducted with Revman5.4 software. Results A total of 13 randomized controlled studies were included, involving 1061 patients. Meta-analysis showed that acceptance and commitment therapy was superior to conventional care on improving depression [SMD=-1.15, 95%CI(-1.48, -0.82), P<0.001], anxiety [SMD=-1.28, 95%CI(-1.53, -1.04), P<0.001], psychological flexibility [MD=-12.26, 95%CI(-15.02, -9.51), P<0.001] and post-traumatic growth [MD=-12.48, 95%CI(-13.55, -11.40), P<0.001], and perceived benefit of disease[MD=-8.77, 95%CI(-10.79, -6.75), P<0.001] of breast cancer patients. Conclusion Acceptance and commitment therapy can relieve depression and anxiety, improve psychological flexibility and post-traumatic growth, and enhance the perceived benefit of disease. It plays a positive role in the improvement of mental state of breast cancer patients.

Key words: Acceptance and Commitment Therapy, Breast Cancer, Psychological Nursing, Meta-Analysis, Evidence-Based Nursing

孙倩倩, 叶红芳, 杨莉. 接纳与承诺疗法对乳腺癌患者干预效果的Meta分析[J]. 中华护理杂志, 2022, 57(9): 1070-1078.

SUN Qianqian, YE Hongfang, YANG Li. Effectiveness of acceptance and commitment therapy on breast cancer patients：a Meta-analysis[J]. Chinese Journal of Nursing, 2022, 57(9): 1070-1078.

图/表 7

表1 纳入文献的基本特征（n=13）

Table 1 Detailed characteristics of the included trials（n=13）

表2 纳入文献的方法学质量评价（n=13）

Table 2 Methodological quality assessment for the included trials（n=13）

图1 接纳与承诺疗法对乳腺癌患者抑郁情绪的影响

Figure 1 Effect of ACT on depression in breast cancer patients

图2 接纳与承诺疗法对乳腺癌患者焦虑水平的影响

Figure 2 Effect of ACT on anxiety level of breast cancer patients

图3 接纳与承诺疗法对乳腺癌患者心理灵活性的影响

Figure 3 Effect of ACT on psychological flexibility of breast cancer patients

图4 接纳与承诺疗法对乳腺癌患者创伤后成长水平的影响

Figure 4 Effect of ACT on post-traumatic growth in breast cancer patients

图5 接纳与承诺疗法对乳腺癌患者疾病感知益处的影响

Figure 5 Effect of ACT on perceived benefit of disease in breast cancer patients

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