恶性骨肿瘤患者照护者真实照护体验的Meta整合

doi:10.3761/j.issn.0254-1769.2023.22.014

摘要/Abstract

摘要：

目的系统评价恶性骨肿瘤患者照护者的真实照护体验。方法计算机检索Cochrane Library、PubMed、Embase、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，检索从建库至2022年11月关于恶性骨肿瘤患者照护者照护体验的质性研究。采用澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute，JBI）循证卫生保健中心质性研究质量评价标准（2016）对文献进行质量评价，并采用汇集性整合方法对结果进行整合。结果共纳入12项研究，提炼出48个主题，归纳形成9个类别，合并为3个整合结果：身心困扰明显；多重角色适应不良；积极调适，获得成长。结论恶性骨肿瘤患者照护者身心困扰明显，渴望多方支持，建议医护人员重视患者多维度需求，制订多元支持策略，帮助照护者角色适应和转换，促进照护者创伤后成长。

关键词: 骨肿瘤, 照护者, 真实体验, 质性研究, 循证护理学

Abstract:

Objective To systematically evaluate the qualitative studies on the care experience of caregivers for primary malignant bone tumors patients，in order to provide references for the construction of bone tumor support care system. Methods The Cochrane Library，PubMed，Embase，CNKI，Wanfang Database，VIP database，and China Biomedical Literature Database were searched by computer to collect qualitative studies on the care experience of caregivers of malignant bone tumors patients from the establishment of the databases to November 2022. The quality of the literature was evaluated using the Joanna Briggs Institute（JBI） Quality Evaluation Criteria for Quality Research in Evidence-Based Health Care Centers（2016），and the results were integrated by a pooled integration approach. Results A total of 12 studies were included；48 themes were extracted and summarized into 9 categories，which were combined into 3 integrated results. Integration result 1 is obvious physical and mental disturbance. Integration result 2 is multiple role maladaptation. Integration result 3 is positive growth after adjustment. Conclusion Caregivers of patients with malignant bone tumors have serious physical and mental burden and are eager for multiple support. It is suggested that medical staff pay attention to the multi-dimensional needs of patients，formulate personalized support strategies，help caregivers adapt and transform their roles，and promote the post-traumatic growth of caregivers.

Key words: Bone Neoplasms, Caregivers, Experience, Qualitative Research, Evidence-Based Nursing

彭涛, 贺开麒, 雷一鹏, 李炳昆, 刘鑫, 赖淋雨, 张玉梅. 恶性骨肿瘤患者照护者真实照护体验的Meta整合[J]. 中华护理杂志, 2023, 58(22): 2785-2791.

PENG Tao, HE Kaiqi, LEI Yipeng, LI Bingkun, LIU Xin, LAI Linyu, ZHANG Yumei. Qualitative studies on experience of the primary malignant bone tumors caregivers：a Meta-synthesis[J]. Chinese Journal of Nursing, 2023, 58(22): 2785-2791.

图/表 3

图1 文献筛选流程图

Figure 1 Literature screening process

表1 纳入文献的基本特征（n=12）

Table 1 The basic characteristics of the included literature（n=12）

表2 纳入文献的质量评价（n=12）

Table 2 Methodological quality evaluation of the included literature（n=12）

参考文献 29

[1]	WHO classification of tumours editorial board. Soft tissue and bone tumours, WHO classification of tumours[M]. 5th ed. Lyon: IARC Press, 2020:321-525.
[2]	倪明. 2021版美国国家综合癌症网络(NCCN)《骨肿瘤临床实践指南》更新与解读[J]. 中国修复重建外科杂志, 2021, 35(9):1186-1191.
	Ni M. Update and interpretation of 2021 National Comprehen-sive Cancer Network(NCCN)“clinical practice guidelines for bone tumors”[J]. Chin J Rep Rec Sur, 2021, 35(9):1186-1191.
[3]	江宁宁. 基于行为转变理论的护理在骨肿瘤化疗患者中的应用[J]. 中华现代护理杂志, 2019, 25(28):3673-3676.
	Jiang NN. Application of nursing based on the theory of behavior change in patients with bone neoplasms chemotherapy[J]. Chin J Mod Nurs, 2019, 25(28):3673-3676.
[4]	侯子伟, 于秀淳. 我国骨肉瘤病人生活质量评价研究现状[J]. 骨科, 2020, 11(6):569-572.
	Hou ZW, Yu XC. Current status of quality of life evaluation of Chinese patients with osteosarcoma[J]. Orthopaedics, 2020, 11(6):569-572.
[5]	段浏华, 薛淑英, 宋彩虹, 等. 恶性骨肿瘤患儿父母创伤后成长及其影响因素分析[J]. 护理管理杂志, 2018, 18(3):171-174.
	Duan LH, Xue SY, Song CH, et al. The level and influencing factors of posttraumatic growth in the parents of children with malignant bone tumor[J]. J Nurs Adm, 2018, 18(3):171-174.
[6]	JBI. Criticl appraisal checklist for qualitative research[EB/OL]. [2020-11-05]. http://joannabriggs.org/research/criticalappraisa-l-tools.html.
[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]	郝桂华, 阮洪, 杨志英. 恶性骨肿瘤患儿直接照护者照顾感受的质性研究[J]. 解放军护理杂志, 2015, 32(16):20-23.
	Hao GH, Ruan H, Yang ZY. A qualitative research on caring experience of malignant bone tumor children’s direct caregivers[J]. Nurs J Chin PLA, 2015, 32(16):20-23.
[9]	黄玲芳, 万昌丽. 儿童及青少年脊柱肿瘤患儿父母负性情绪的质性研究[J]. 解放军护理杂志, 2017, 34(9):8-12.
	Huang LF, Wan CL. Qualitative study of negative emotion in parents of children or adolescents with spinal tumor[J]. Nurs J Chin PLA, 2017, 34(9):8-12.
[10]	刘媛, 胡爱玲, 张美芬. 骨肉瘤病人父母照护体验的质性研究[J]. 护理研究, 2013, 27(29):3231-3233.
	Liu Y, Hu AL, Zhang MF. Qualitative research on care experience of parents of patients with osteosarcoma[J]. Chin Nurs Res, 2013, 27(29):3231-3233.
[11]	张雪莲, 山慈明, 张俊娟. 骨肉瘤病人家属照顾负荷的质性研究[J]. 护理研究, 2013, 27(23):2465-2466.
	Zhang XL, Shan CM, Zhang JJ. Qualitative research on caring burden of families of osteosarcoma patients[J]. Chin Nurs Res, 2013, 27(23):2465-2466.
[12]	欧阳晓琳, 汪紫璐, 沈芳, 等. 骨肉瘤患儿父母照护体验的质性研究[J]. 当代护士(下旬刊), 2021, 28(12):111-114.
	Ouyang XL, Wang ZL, Shen F, et al. Qualitative study of parental care experience of children with osteosarcoma[J]. Today Nur-ses, 2021, 28(12):111-114.
[13]	涂宗勍, 欧阳芸, 朱唯一, 等. 骨肉瘤患者照护者创伤后成长体验的现象学研究[J]. 上海护理, 2018, 18(12):29-33.
	Tu ZQ, Ouyang Y, Zhu WY, et al. A qualitative research on posttraumatic growth in caregivers of patients with osteosarcoma[J]. Shanghai Nurs, 2018, 18(12):29-33.
[14]	Demiralp M, Hatipoglu S, Iyigun E, et al. Living with a malignant musculoskeletal tumor:experiences of family caregivers[J]. Orthop Nurs, 2010, 29(2):86-91. DOI PMID
[15]	Luo CM, Lei L, Yu Y, et al. The perceptions of patients,fami-lies,doctors,and nurses regarding malignant bone tumor dis-closure in China:a qualitative study[J]. J Transcult Nurs, 2021, 32(6):740-748. DOI URL
[16]	Shunmugasundaram C, Veeraiah S. Caregivers’ perception of psychosocial issues of pediatric patients with osteosarcoma:an exploratory study[J]. J Psychosoc Oncol Res Pract, 2020, 2:1(e15).
[17]	Vaarwerk B, Limperg PF, Naafs-Wilstra MC, et al. Getting control during follow-up visits:the views and experiences of parents on tumor surveillance after their children have completed therapy for rhabdomyosarcoma or Ewing sarcoma[J]. Supportive Care Cancer, 2019, 27(10):3841-3848. DOI
[18]	Chan CM, Lindsay AD, Spiguel ARV, et al. Why rotationplasty a qualitative study of decision-making by families of patients with primary bone sarcoma[J]. J Patient Exp, 2022, 9:1-7.
[19]	Earle EA, Eiser C, Grimer R. ‘He never liked sport anyway’-mother’s views of young people coping with a bone tumour in the lower limb[J]. Sarcoma, 2005, 9(1/2):7-13. DOI URL
[20]	余逸枝. 骨肉瘤患者家庭照顾者社会支持、生活质量与照护负担的相关性研究[J]. 中国医刊, 2019, 54(6):673-676.
	Yu YZ. Investigation on the burden of family caregivers of osteosarcoma patients[J]. Chin J Med, 2019, 54(6):673-676.
[21]	Adelman RD, Tmanova LL, Delgado D, et al. Caregiver burden: a clinical review[J]. JAMA, 2014, 311(10):1052-60. DOI PMID
[22]	王乙舒, 陈华英. 医-护-社工一体化模式在肿瘤患者人文关怀中的实践[J]. 护理学杂志, 2017, 32(14):61-64.
	Wang YS, Chen HY. Practice of physician-nurse-social worker collaborative human caring in oncology patients[J]. J Nurs Sci, 2017, 32(14):61-64.
[23]	何龙韬, 吴汉. 中国癌症患者家庭照护者照护经历的质性Meta整合[J]. 中国全科医学, 2022, 25(4):416-423.
	He LT, Wu H. Experiences of family caregivers of Chinese cancer patients:a qualitative Meta-synthesis[J]. Chin Gen Prac, 2022, 25(4):416-423.
[24]	郑红颖, 胡嘉乐, 董柏君, 等. 医患共享决策评估工具的研究进展[J]. 中华护理杂志, 2018, 53(5):622-625.
	Zheng HY, Hu JL, Dong BJ, et al. Research progress and eva-luation of assessment tools for shared decision making[J]. Chin J Nurs, 2018, 53(5):622-625.
[25]	杨昕宇, 吕利明, 王硕, 等. 癌症幸存者社会疏离的研究进展[J]. 中华护理杂志, 2020, 55(8):1270-1275. DOI
	Yang XY, Lü LM, Wang S, et al. Research progress of social isolation among cancer survivors[J]. Chin J Nurs, 2020, 55(8):1270-1275.
[26]	陈娟娟, 李惠萍, 张婷, 等. 癌症患者及其配偶二元关系的研究进展[J]. 解放军护理杂志, 2021, 38(12):79-81.
	Chen JJ, Li HP, Zhang T, et al. Research progress of the bi-nary relationship between cancer patients and their spouses[J]. Nurs J Chin PLA, 2021, 38(12):79-81.
[27]	刘颖, 陈佳丽, 宁宁, 等. 骨肿瘤手术患者创伤后成长的调查研究[J]. 中华护理杂志, 2022, 57(10):1184-1190. DOI
	Liu Y, Chen JL, Ning N, et al. Study on the relationship bet-ween post-traumatic stress and post-traumatic growth in pa-tients with bone neoplasms surgery[J]. Chin J Nurs, 2022, 57(10):1184-1190.
[28]	陆晚, 李文藻, 许辰, 等. 6岁以下发育障碍患儿祖父母创伤后成长体验的质性研究[J]. 中华护理杂志, 2022, 57(18):2225-2231.
	Lu W, Li WZ, Xu C, et al. Posttraumatic growth experience of grandparents of children with developmental disabilities under 6 years old:a qualitative study[J]. Chin J Nurs, 2022, 57(18): 2225-2231.
[29]	杨艳. 叙事护理实践模式的构建与实施:以肿瘤护理为例[D]. 上海: 海军军医大学, 2020.
	Yang Y. Construction and implementation of narrative nursing practice model:take cancer nursing as an example[D]. Shang-hai: Naval Medical University, 2020.