基于“互联网+”的护理干预对癌症患者疼痛影响的Meta分析

doi:10.3761/j.issn.0254-1769.2023.09.005

摘要/Abstract

摘要：

目的系统评价基于“互联网+”的护理干预对癌症患者疼痛的干预效果并探索最佳的干预形式。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、维普数据库、万方数据库和中国生物医学文献数据库中关于基于“互联网+”的护理干预对癌症患者疼痛效果的随机对照试验，检索时限为建库至2022年5月。由2名研究者独立进行文献筛选、资料提取、文献质量评价，采用RevMan 5.4软件进行Meta分析。结果共纳入9篇文献，包括1 049例患者。Meta分析结果显示，与常规护理相比，基于“互联网+”的护理干预能够有效降低癌症患者的疼痛强度[MD=-0.70，95%CI（-1.29，-0.11），P=0.03]、减少疼痛干扰[MD=-0.71，95%CI（-1.08，-0.33），P=0.04]；干预形式中，互动式健康教育组疼痛强度最低，差异具有统计学意义[MD=-0.23，95%CI（-0.43，-0.02），I²=0，P=0.03]。此外，基于“互联网+”的护理干预对50~<60岁癌症患者的疼痛强度改善效果更明显[MD=-0.26，95%CI（-0.46，-0.06），I²=0，P=0.01]。结论实施基于“互联网+”的护理干预能有效改善癌症患者的疼痛强度与疼痛干扰；互动式健康教育是最佳的干预形式。

关键词: 癌症, 互联网+, 疼痛, Meta分析, 循证护理学

Abstract:

Objective To systematically evaluate the impact of the nursing intervention model based on “Internet +” with cancer pain patients，and to explore the best intervention based on “Internet +” to alleviate their pain. Methods A systematic search of PubMed，Embase，Web of Science，Cochrane Library，CNKI，VIP，WanFang Data and CBM，was carried out to collect randomized controlled trials on nursing intervention model based on “Internet +” on cancer pain patients from inception to May 2022. There were 2 researchers who screened the literature，extracted data and evaluated the methodological quality. Meta-analysis was conducted with Revman 5.4 software. Results A total of 9 randomized controlled studies were included，involving 1049 patients. The results of the Meta-analysis showed that，compared to the conventional care，the nursing intervention model based on “Internet +” was effective in improving pain intensity in cancer patients[MD=-0.70，95%CI（-1.29，-0.11），P=0.03]，pain interference [MD=-0.71，95%CI（-1.08，-0.33），P=0.04]. In different “Internet +” intervention forms of each group，patients in the interactive health education group had the lowest pain intensity score，with significant statistical differences[MD=-0.23，95%CI（-0.43，-0.02），I²=0，P=0.03]. In addition，nursing intervention based on “Internet +” has a more significant improvement effect on pain intensity in cancer patients aged 50 to 60 years[MD=-0.26，95%CI（-0.46，-0.06），I²=0，P=0.01]. Conclusion The nursing intervention model based on “Internet+” can effectively improve the pain intensity and pain interference in cancer patients. Interactive health education is the best form of intervention.

Key words: Cancer, Internet+, Pain, Meta Analysis, Evidence-Based Nursing

雒晓燕, 崔仁善, 许秀梅, 崔苗苗, 郭玲茹, 周丹. 基于“互联网+”的护理干预对癌症患者疼痛影响的Meta分析[J]. 中华护理杂志, 2023, 58(9): 1056-1062.

LUO Xiaoyan, CUI Renshan, XU Xiumei, CUI Miaomiao, GUO Lingru, ZHOU Dan. Effectiveness of “Internet+” nursing intervention model on pain in cancer patients：a Meta-analysis[J]. Chinese Journal of Nursing, 2023, 58(9): 1056-1062.

图/表 4

表1 纳入文献的基本特征（n=9）

Table 1 Characteristics of included studies（n=9）

表2 纳入文献的方法学质量评价（n=9）

Table 2 Methodological quality assessment for the included studies（n=9）

图1 基于“互联网+”的护理干预对癌症患者疼痛强度的影响

Figure 1 Effect of the nursing intervention based on “Internet +” on pain intensity in cancer patients

图2 基于“互联网+”的护理干预对癌症患者疼痛干扰的影响

Figure 2 Effect of the nursing intervention based on “Internet +” on pain interference in cancer patients

参考文献 33

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. DOI URL
[2]	Chen WQ, Zheng RS, Baade PD, et al. Cancer statistics in China,2015[J]. CA A Cancer J Clin, 2016, 66(2):115-132. DOI URL
[3]	丁群芳, 黄静, 江子芳, 等. 癌症疼痛规范化管理信息平台的构建及应用[J]. 中华护理杂志, 2020, 55(3):387-391. DOI
	Ding QF, Huang J, Jiang ZF, et al. Effect assessment of an information platform for standardized nursing management of cancer pain[J]. Chin J Nurs, 2020, 55(3):387-391. DOI
[4]	吴晓丹, 郑美春, 张美芬, 等. 癌症患者症状困扰测评工具的研究进展[J]. 中华护理杂志, 2016, 51(2):200-205.
	Wu XD, Zheng MC, Zhang MF, et al. Research progress of cancer symptom distress assessment tools[J]. Chin J Nurs, 2016, 51(2):200-205.
[5]	Swarm RA, Paice JA, Anghelescu DL, et al. Adult cancer pain,version 3.2019,NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2019, 17(8):977-1007. DOI URL
[6]	van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, et al. Prevalence of pain in patients with cancer:a systematic review of the past 40 years[J]. Ann Oncol, 2007, 18(9):1437-1449. DOI PMID
[7]	Sela RA, Bruera E, Conner-Spady B, et al. Sensory and affective dimensions of advanced cancer pain[J]. Psychooncology, 2002, 11(1):23-34. PMID
[8]	解红文, 马翠, 丁腊春, 等. “互联网+”目标管理模式在妊娠期糖尿病孕妇的应用[J]. 护理学杂志, 2019, 34(16):22-25.
	Xie HW, Ma C, Ding LC, et al. Application of target management model based on “Internet+” in women with gestational diabetes[J]. J Nurs Sci, 2019, 34(16):22-25.
[9]	冯薇, 解红文, 丁腊春, 等. 应用多学科诊疗模式提高妊娠期糖尿病孕妇自我管理能力的实践[J]. 中国护理管理, 2019, 19(3):428-432.
	Feng W, Xie HW, Ding LC, et al. The effect of MDT mode on improving the self-management ability of pregnant women with gestational diabetes mellitus[J]. Chin Nurs Manag, 2019, 19(3):428-432.
[10]	Mikolasek M, Berg J, Witt CM, et al. Effectiveness of mindfulness-and relaxation-based eHealth interventions for patients with medical conditions:a systematic review and synthesis[J]. Int J Behav Med, 2018, 25(1):1-16. DOI PMID
[11]	Jeminiwa R, Hohmann L, Qian JJ, et al. Impact of eHealth on medication adherence among patients with asthma:a systematic review and meta-analysis[J]. Respir Med, 2019, 149:59-68. DOI PMID
[12]	Zhang L, McLeod HL, Liu KK, et al. Effect of physician-pharmacist participation in the management of ambulatory cancer pain through a digital health platform:randomized controlled trial[J]. JMIR Mhealth Uhealth, 2021, 9(8):e24555. DOI URL
[13]	Yang J, Weng LZ, Chen ZK, et al. Development and testing of a mobile app for pain management among cancer patients discharged from hospital treatment:randomized controlled trial[J]. JMIR Mhealth Uhealth, 2019, 7(5):e12542. DOI URL
[14]	Somers TJ, Kelleher SA, Westbrook KW, et al. A small randomized controlled pilot trial comparing mobile and traditional pain coping skills training protocols for cancer patients with pain[J]. Pain Res Treat, 2016, 2016:2473629.
[15]	Sun YH, Jiang F, Gu JJ, et al. Development and testing of an intelligent pain management system(IPMS) on mobile phones through a randomized trial among Chinese cancer patients:a new approach in cancer pain management[J]. JMIR Mhealth Uhealth, 2017, 5(7):e108. DOI URL
[16]	Yun YH, Lee KS, Kim YW, et al. Web-based tailored education program for disease-free cancer survivors with cancer-related fatigue:a randomized controlled trial[J]. J Clin Oncol, 2012, 30(12):1296-1303. DOI URL
[17]	李香风, 刘薇. 微信对改善癌症患者疼痛强度及服药依从性的效果评价[J]. 中华护理杂志, 2015, 50(12):1454-1457.
	Li XF, Liu W. Effects of WeChat intervention on medication adherence and pain intensity in cancer patients[J]. Chin J Nurs, 2015, 50(12):1454-1457.
[18]	Peng ZY, Li L, Chen Y, et al. WeChat app-based reinforced education improves the quality of opioid titration treatment of cancer-related pain in outpatients:a randomized control study[J]. BMC Cancer, 2020, 20(1):852. DOI
[19]	Smith SK, MacDermott K, Amarasekara S, et al. Reimagine:a randomized controlled trial of an online,symptom self-management curriculum among breast cancer survivors[J]. Support Care Cancer, 2019, 27(5):1775-1781. DOI PMID
[20]	Chee W, Lee Y, Im EO, et al. A culturally tailored Internet cancer support group for Asian American breast cancer survivors:a randomized controlled pilot intervention study[J]. J Telemed Telecare, 2017, 23(6):618-626. DOI URL
[21]	Fairchild A. Under-treatment of cancer pain[J]. Curr Opin Support Palliat Care, 2010, 4(1):11-15. DOI URL
[22]	Agboola S, Kamdar M, Flanagan C, et al. Pain management in cancer patients using a mobile app:study design of a randomized controlled trial[J]. JMIR Res Protoc, 2014, 3(4):e76. DOI URL
[23]	Li JJ, Zhu CM, Liu CH, et al. Effectiveness of eHealth interventions for cancer-related pain,fatigue,and sleep disorders in cancer survivors:a systematic review and meta-analysis of randomized controlled trials[J]. J Nurs Scholarsh, 2022, 54(2):184-190. DOI URL
[24]	Lin JX, Baumeister H. Internet-und mobilebasierte interventionen in der psychotherapie[J]. Public Health Forum, 2015, 23(3):176-179. DOI URL
[25]	Andersson G. Internet-delivered psychological treatments[J]. Annu Rev Clin Psychol, 2016, 12:157-179. DOI URL
[26]	Zheng CY, Chen X, Weng LZ, et al. Benefits of mobile APPs for cancer pain management:systematic review[J]. JMIR Mhealth Uhealth, 2020, 8(1):e17055. DOI URL
[27]	Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain[J]. Eur J Can Care, 2017, 26(2):e12457.
[28]	魏建梅, 王志剑, 夏梅, 等. 系统化疼痛护理管理模式在临床疼痛护理实践中的应用[J]. 中国疼痛医学杂志, 2019, 25(7):531-536.
	Wei JM, Wang ZJ, Xia M, et al. Research and application of pain care management mode in general hospitals[J]. Chin J Pain Med, 2019, 25(7):531-536.
[29]	Malone MD, Strube MJ. Meta-analysis of non-medical treatments for chronic pain[J]. Pain, 1988, 34(3):231-244. DOI PMID
[30]	刘珍, 张艳, 李宏洁, 等. 郑州市社区居民对“互联网+护理服务”使用意愿及影响因素[J]. 护理学杂志, 2020, 35(3):77-79.
	Liu Z, Zhang Y, Li HJ, et al. Willingness to use “Internet+nursing services” among community residents in Zhengzhou and its influencing factors[J]. J Nurs Sci, 2020, 35(3):77-79.
[31]	Wang XS, Mendoza TR, Gao SZ, et al. The Chinese version of the Brief Pain Inventory(BPI-C):its development and use in a study of cancer pain[J]. Pain, 1996, 67(2):407-416. DOI URL
[32]	董晓升. 应用互联网手段多样性运动组合对乳腺癌术后患者康复作用的研究[D]. 济南: 山东师范大学, 2019.
	Dong XS. Study on the rehabilitation effect of diverse exercise combination with Internet means on postoperative breast cancer patients[D]. Jinan: Shandong Normal University, 2019.
[33]	Probst T, Baumeister H, McCracken LM, et al. Baseline psychological inflexibility moderates the outcome pain interference in a randomized controlled trial on Internet-based acceptance and commitment therapy for chronic pain[J]. J Clin Med, 2018, 8(1):24. DOI URL