SCI荐读第4期 | 肺癌患者疲劳疼痛睡眠障碍症状群的非药物干预:最佳证据总结

Objectives

This study aimed to summarize the most effective evidence on nonpharmacological interventions for the fatigue-pain-sleep disturbance symptom cluster in lung cancer patients and to provide evidence-based management methods for clinical team and lung cancer patients. 

Methods

Guided by the "6S" pyramid model, we retrieved evidence on fatigue, pain, and sleep disturbance management from relevant websites and databases, and unpublished gray literature was also searched. The time frame of the search ranged from database establishment to September 30, 2023. Two researchers independently evaluated the literature quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) for guidelines, and the Assessment of Multiple Systematic Reviews II (AMSTAR II) for systematic reviews. Two people independently extracted and summarized the evidence according to the first principle of high-quality evidence and newly published evidence. The included evidence was graded by the JBI Evidence Pre-Grading System. 

Results

A total of 52,238 articles were retrieved, of which 60 articles, including 18 guidelines, 18 JBI best practice recommendations, one Up To Date clinical practice, and 23 systematic reviews, were included. Overall, 49 pieces of evidence from six dimensions—screening, assessment, management, education, referral, and follow-up—were summarized. Forty-three pieces of evidence were level 1, three pieces of evidence were level 4, and three pieces of evidence were level 5. 

Conclusions

The best 49 pieces of evidence on nonpharmacological interventions for the fatigue-pain-sleep disturbance symptom cluster in lung cancer patients were summarized in this study, and these nonpharma-cological interventions are scientific and comprehensive.  Implications for Nursing Practice: This study can provide guidance for clinical team to improve the fatigue-pain-sleep disturbance symptom cluster management. These evidence items can be implemented by clinical team to reduce the symptom burden and improve the self-management ability of symptoms in lung cancer patients. 

目的

本研究旨在总结非药物干预治疗癌症患者疲劳-睡眠障碍症状群的最有效证据，为临床团队和癌症患者提供循证管理方法。

方法

在“6S”金字塔模型的指导下，我们从相关网站和数据库中检索了疲劳、疼痛和睡眠障碍管理的证据，并搜索了未发表的灰色文献。检索时间为数据库建立到2023年9月30日。两名研究人员分别使用《研究和评估指南II评估》（AGREE II）和《多系统评价II评估》对文献质量进行了评估。两人按照高质量证据和新公布证据优先的原则，独立提取和总结了证据。所包含的证据由JBI证据预分级系统进行分级。

结果

共检索到52238篇文章，其中包括60篇文章，包括18篇指南、18篇JBI最佳实践建议、1篇最新临床实践和23篇系统评价。总的来说，从筛查、评估、管理、教育、转诊和随访6个维度总结了49条证据。其中43条证据为一级证据，3条证据为四级证据，3条证据为五级证据。

结论

本研究总结了对癌症患者疲劳-睡眠障碍症状群进行非药物干预的49条最佳证据，这些非药物干预措施是科学和全面的。对临床护理实践的启示：本研究可为临床护理团队改善癌症患者疲劳疼痛睡眠障碍症状群提供指导。临床团队可进行证据应用和实施，以减轻癌症患者的症状负担，提高症状的自我管理能力。

肺癌患者治疗期间的症状负担影响患者的治疗信心和依从性。严重的症状负担会使患者认为治疗无效，影响患者的信心。治疗引起的症状负担会给患者造成干扰和疼痛，如果这种疼痛远远超过治疗的效果，患者就会中断治疗，影响治疗的连续性和坚持性。症状管理是临床团队和患者急需解决的问题，该研究总结了目前对癌症患者疲劳-睡眠障碍症状群进行非药物干预的最佳证据。大多数证据来自指南、高质量的最佳实践和临床实践指南，总体质量很高，从筛查，评估，管理，教育，转诊和随访6个维度总结了49项针对肺癌患者疲劳-疼痛-睡眠障碍症状群的非药物干预措施。确定了6个步骤和49个干预措施，可由临床团队实施，以减少肺癌患者的症状负担和提高自我管理能力。可为临床团队、肺癌患者及其家属提供有益的参考。该研究也可为进一步的干预研究提供指导。

该研究纳入的文章数量多、内容广、异质性大，增加了确定证据可操作性的难度。为了实现证据转化，临床团队应将真实的临床情况与患者的接受度和依赖性相结合，为癌症患者疲劳-疼痛-睡眠障碍症状群形成可行的非药物干预方案。此外，该研究中包含的文献来自不同的国家。在国内转化证据时，应根据癌症患者自身的文化背景、疾病特征和治疗方法，选择合适的证据，制定针对其疲劳-睡眠障碍症状群的局部非药物干预策略，有效缓解其症状，提高其生活质量。

本篇由护理循证及品质管理马倩文投稿分享

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