癌症患者复发恐惧体验质性研究的Meta整合

doi:10.3761/j.issn.0254-1769.2023.20.014

摘要/Abstract

摘要：

目的系统评价与分析癌症患者复发恐惧体验的质性研究，旨在为医护工作者给予癌症患者心理支持提供依据。方法系统检索Cochrane Library、PubMed、Embase、Web of Science、PsycINFO、CINAHL、中国生物医学文献数据库、万方数据库、中国知网和维普数据库，检索关于癌症患者复发恐惧体验的质性研究，检索时限为建库至2022年6月。根据乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价工具对文献进行质量评价，采用汇集型整合法对纳入的文献进行整合与分析。结果最终共纳入13篇文献，提取59个研究结果，最终归纳为3个整合结果：癌症复发恐惧存在多重典型表现、癌症复发恐惧的触发因素复杂、癌症复发恐惧的应对策略多样，共14个类别。结论医护人员在理解癌症患者复发恐惧的多重表现、触发因素和个人应对差异的基础上，可联合患者、家属和社会工作者共同建构医院-家庭-社会一体化的综合支持模式，以纠正非理性认知，消除复发不确定感，积极勇敢地面对恐惧，从而提高生活质量。

关键词: 癌症, 复发恐惧, 质性研究, Meta整合, 循证护理学

Abstract:

Objective To systematically evaluate and analyze the qualitative research about the fear of recurrence in cancer patients，in order to help medical workers to provide the psychological support for cancer patients. Methods Qualitative studies about the fear of recurrence in cancer patients were systematically searched from Cochrane Library，PubMed，Embase，Web of Science，PsycINFO，CINAHL，SinoMed，Wanfang Database，CNKI and VIP database，and the search time limit was from the establishment of the databases to June 2022. The quality of the literature was evaluated according to the JBI Critical Appraisal Checklist for Qualitative Research，and the included literature was integrated and analyzed using the integrating method. Results A total of 13 pieces of the literature were included，and 59 research results were extracted，which were finally summarized into 14 categories and 3 integrated results：multiple typical manifestations of the fear of cancer recurrence，complex triggering factors of the fear of cancer recurrence，and diverse coping strategies of the fear of cancer recurrence. Conclusion On the basis of understanding the multiple manifestations，triggers and individual coping differences of cancer patients’ fear of recurrence，medical staff can cooperate with patients，family members and social workers to construct a comprehensive support model of hospital-family-society integration，so as to correct irrational cognition，eliminate the uncertainty of recurrence，face the fear bravely and positively，so as to improve the quality of life.

Key words: Cancer, Fear of Recurrence, Qualitative Research, Meta-Synthesis, Evidence-Based Nursing

叶铖林, 刘红彦, 张秀伟, 陈秋强, 张晓旭, 张梦甜. 癌症患者复发恐惧体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(20): 2530-2537.

YE Chenglin, LIU Hongyan, ZHANG Xiuwei, CHEN Qiuqiang, ZHANG Xiaoxu, ZHANG Mengtian. Fear of cancer recurrence in cancer patients：a qualitative Meta-synthesis[J]. Chinese Journal of Nursing, 2023, 58(20): 2530-2537.

图/表 3

图1 PubMed的检索策略

Figure 1 PubMed search strategies

表1 纳入文献的基本特征（n=15）

Table 1 The basic characteristics of the included literature（n=15）

表2 纳入文献的方法学质量评价（n=15）

Table 2 Methodological quality evaluation of included studies（n=15）

参考文献 37

[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]	Lebel S, Ozakinci G, Humphris G, et al. From normal response to clinical problem:definition and clinical features of fear of cancer recurrence[J]. Support Care Cancer, 2016, 24(8):3265-3268. DOI URL
[3]	Cohee AA, Adams RN, Johns SA, et al. Long-term fear of re-currence in young breast cancer survivors and partners[J]. Psychooncology, 2017, 26(1):22-28. DOI URL
[4]	张阳, 田丽, 高月乔, 等. 癌症患者复发恐惧的研究进展[J]. 中华护理杂志, 2017, 52(8):997-1001.
	Zhang Y, Tian L, Gao YQ, et al. Research progress on fear of cancer recurrence among cancer patients[J]. Chin J Nurs, 2017, 52(8):997-1001.
[5]	Hu XC, Wang WD, Wang Y, et al. Fear of cancer recurrence in patients with multiple myeloma:prevalence and predictors based on a family model analysis[J]. Psychooncology, 2021, 30(2):176-184. DOI URL
[6]	Institute JB. Critical appraisal checklist for qualitative research[EB/OL].(2022-08-22)[2022-11-08]. https://jbi.global/critical-appraisal-tools.
[7]	Lockwood C, Munn Z, Porritt K. Qualitative research synthesis:methodological guidance for systematic reviewers utilizing meta-aggregation[J]. Int J Evid Based Healthc, 2015, 13(3):179-187. DOI URL
[8]	Hamama-Raz Y, Shinan-Altman S, Levkovich I. The intraperso-nal and interpersonal processes of fear of recurrence among cervical cancer survivors:a qualitative study[J]. Support Care Cancer, 2022, 30(3):2671-2678. DOI
[9]	杨峰, 邵锋伟. 癌症复发恐惧对于鼻咽癌患者生活质量影响的质性研究[J]. 中国乡村医药, 2019, 26(20):47-48.
	Yang F, Shao FW. Qualitative study on the influence of cancer recurrence fear on the quality of life of patients with nasopharyngeal carcinoma[J]. Chin J Rural Med Pharm, 2019, 26(20):47-48.
[10]	Taylor C, Richardson A, Cowley S. Surviving cancer treatment:an investigation of the experience of fear about,and monito-ring for,recurrence in patients following treatment for colo-rectal cancer[J]. Eur J Oncol Nurs, 2011, 15(3):243-249. DOI URL
[11]	McLoone J, Watts K, Menzies S, et al. When the risks are high:psychological adjustment among melanoma survivors at high risk of developing new primary disease[J]. Qual Health Res, 2012, 22(8):1102-1113. DOI URL
[12]	Şengün İnan F, Üstün B. Fear of recurrence in Turkish breast cancer survivors:a qualitative study[J]. J Transcult Nurs, 2019, 30(2):146-153. DOI PMID
[13]	De Vries J, Den Oudsten BL, Jacobs PM, et al. How breast cancer survivors cope with fear of recurrence:a focus group study[J]. Support Care Cancer, 2014, 22(3):705-712. DOI URL
[14]	Galica J, Giroux J, Francis JA, et al. Coping with fear of can-cer recurrence among ovarian cancer survivors living in small urban and rural settings:a qualitative descriptive study[J]. Eur J Oncol Nurs, 2020, 44:101705. DOI URL
[15]	Lai WS, Shu BC, Hou WL. A qualitative exploration of the fear of recurrence among Taiwanese breast cancer survivors[J]. Eur J Cancer Care, 2019, 28(5):e13113.
[16]	Hong SJ, Shin NM. Fear of cancer recurrence in Korean women after breast cancer treatment:a mixed methods study[J]. Eur J Oncol Nurs, 2021, 54:102010. DOI URL
[17]	Mutsaers B, Jones G, Rutkowski N, et al. When fear of cancer recurrence becomes a clinical issue:a qualitative analysis of features associated with clinical fear of cancer recurrence[J]. Support Care Cancer, 2016, 24(10):4207-4218. DOI URL
[18]	Thewes B, Lebel S, Seguin Leclair C, et al. A qualitative ex-ploration of fear of cancer recurrence(FCR) amongst Aus-tralian and Canadian breast cancer survivors[J]. Support Care Cancer, 2016, 24(5):2269-2276. DOI PMID
[19]	Maheu C, Hébert M, Louli J, et al. Revision of the fear of cancer recurrence cognitive and emotional model by Lee-Jones et al with women with breast cancer[J]. Cancer Rep (Hoboken), 2019, 2(4):e1172.
[20]	Hedman C, Strang P, Djärv T, et al. Anxiety and fear of recur-rence despite a good prognosis:an interview study with diffe-rentiated thyroid cancer patients[J]. Thyroid, 2017, 27(11):1417-1423. DOI URL
[21]	Vickberg SJ. Fears about breast cancer recurrence[J]. Cancer Pract, 2001, 9(5):237-243. DOI URL
[22]	Galica J, Saunders S, Haase K, et al. Writing between the lines:a secondary analysis of unsolicited narratives from cancer survivors regarding their fear of cancer recurrence[J]. Can Oncol Nurs J, 2021, 31(1):83-91. DOI URL
[23]	Mutsaers B, Butow P, Dinkel A, et al. Identifying the key cha-racteristics of clinical fear of cancer recurrence:an inter-national Delphi study[J]. Psychooncology, 2020, 29(2):430-436. DOI URL
[24]	Ellis A. The revised ABC’s of rational-emotive therapy(RET)[J]. J Rational-Emot Cognitive-Behav Ther, 1991, 9(3):139-172. DOI URL
[25]	陆悦, 黎佳思, 周书, 等. 抑郁障碍患者躯体化症状与BMI、睡眠和认知功能的相关性[J]. 中华行为医学与脑科学杂志, 2021, 30(2):134-138.
	Lu Y, Li JS, Zhou S, et al. Association between somatization symptoms and BMI,sleep and cognitive function in patients with depression[J]. Chin J Behav Med Brain Sci, 2021, 30(2):134-138.
[26]	Parker D, Byng R, Dickens C, et al. Patients’ experiences of seeking help for emotional concerns in primary care:doctor as drug,detective and collaborator[J]. BMC Fam Pract, 2020, 21(1):35. DOI PMID
[27]	潘明月, 赵佳鑫, 黄海群, 等. 网络化认知行为疗法在乳腺癌患者中的研究进展[J]. 中华护理杂志, 2022, 57(3):363-367. DOI
	Pan MY, Zhao JX, Huang HQ, et al. Research progress of Internet-based cognitive behavioral therapy in breast cancer patients[J]. Chin J Nurs, 2022, 57(3):363-367. DOI
[28]	Lengacher CA, Reich RR, Ramesar S, et al. Feasibility of the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program for symptom improvement among breast cancer survivors[J]. Psychooncology, 2018, 27(2):524-531. DOI PMID
[29]	林素红, 郎杉, 岳爱华. 团体心理干预联合叙事护理在结直肠癌患者心理调适中的应用价值[J]. 中华现代护理杂志, 2020, 26(27):3808-3812.
	Lin SH, Lang S, Yue AH. Application value of group psycho-logical intervention combined with narrative nursing in the psychological adjustment of patients with colorectal cancer[J]. Chin J Mod Nurs, 2020, 26(27):3808-3812.
[30]	Mishel MH. Uncertainty in illness[J]. Image J Nurs Scholarsh, 1988, 20(4):225-232.
[31]	刘朦朦, 孙小越, 郝雨, 等. 医患共同决策中的信任和沟通[J]. 医学与哲学, 2021, 42(14):26-29.
	Liu MM, Sun XY, Hao Y, et al. Trust and communication in shared decision-making[J]. Med & Philos, 2021, 42(14):26-29.
[32]	Mehnert A, Hartung TJ, Friedrich M, et al. One in two cancer patients is significantly distressed:prevalence and indicators of distress[J]. Psychooncology, 2018, 27(1):75-82. DOI PMID
[33]	Oztas B, Ugurlu M, Kurt G. Fear of cancer recurrence and coping attitudes of breast cancer survivors[J]. Eur J Cancer Care (Engl), 2022, 31(6):e13742.
[34]	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):1070-1079. DOI
	Sun QQ, Ye HF, Yang L. Effectiveness of acceptance and commitment therapy on breast cancer patients:a Meta-analysis[J]. Chin J Nurs, 2022, 57(9):1070-1079.
[35]	常鹄, 马飞, 梅志红, 等. 肿瘤医院乳腺癌健康讲座的效果评价和持续改进[J]. 中国肿瘤, 2017, 26(11):882-885.
	Chang H, Ma F, Mei ZH, et al. Evaluation and continuous improvement of breast cancer health lecture in cancer hospital[J]. China Cancer, 2017, 26(11):882-885.
[36]	Bowen M. Family therapy in clinical practice[M]. Jason Aron-son, 1993.
[37]	王霞, 丁焱, 游菁, 等. 妇科恶性肿瘤患者同伴支持者角色认知与支持体验的研究[J]. 中华护理杂志, 2018, 53(11):1292-1297.
	Wang X, Ding Y, You J, et al. A qualitative research on role cognition and experience among peer supporters of gynecological cancer patients[J]. Chin J Nurs, 2018, 53(11):1292-1297.