Self-guided interventions for managing psychological distress in people with cancer – A systematic review

ObjectivePeople with cancer can experience psychological distress but do not always desire, or engage with, professional support to assist with managing distress. Interventions that are self-directed or guided by patients may hold promise as they allow patients to engage with interventions as they need. The objective of this review is to describe and appraise the evidence for effectiveness of self-guided interventions that aim to manage psychological distress in people with cancer.MethodsA systematic search of Medline, PsychInfo and CINAHL identified 15 relevant papers, reporting on 14 studies.ResultsOf the interventions, three studies comprised hard-copy workbooks, six studies used resource packs, four were online resources and one was a brief multimedia resource. One study was adequately powered and demonstrated a positive effect. Almost all interventions required some level of facilitation. Distressed participants may benefit more from interventions.ConclusionSelf-guided interventions represent a potentially efficient way of delivering support for people affected by cancer, however evidence supporting them is lacking.Practice implicationsThere is a need to generate evidence to understand the impact of self-guided interventions for: i) the ideal delivery point in the disease trajectory, ii) patient groups, iii) intervention content and iv) type and mode of delivery.     

乳腺癌PICC化疗患者自我管理行为测评量表的开发与应用

目的 开发乳腺癌经外周静脉置入中心静脉导管（PICC）化疗患者自我管理行为测评量表,并进行效度和信度检验。方法 参考美国斯坦福大学患者教育研究中心Dr.Kate.Lorig等创建的《慢性病自我管理研究测量表》及其评分标准,结合乳腺癌PICC患者自我管理内容,经参考文献、专家评定,修订成《乳腺癌PICC化疗患者自我管理行为测评量表》。量表包括5个维度,19项量化指标,共78个条目。192例乳腺癌PICC化疗患者参加了调查。结果 有效问卷178份,量表的内容效度指数（CVI）为0.906,总体Cronbach’α系数为0.892。采用因子分析法,提取出特征根大于1的公因子4个,解释总方差的41.180%,每个条目在相应因子上的负荷均在0.3以上。结论此测评量表具有较好的效度和信度,为研究者提供了乳腺癌PICC化疗患者自我管理行为评价和干预的工具。     

儿童青少年1型糖尿病患儿的压力和应对方式对其疾病自我管理的影响

目的 探讨人口学、疾病相关特征、压力、应对方式对儿童青少年1型糖尿病患儿疾病自我管理水平的影响。方法 采用横断面调查研究设计，纳入149名儿童青少年1型糖尿病患儿（8~20岁）。采用一般资料收集表、儿童青少年1型糖尿病自我管理量表、压力知觉量表、青少年应对方式量表进行调查。结果 149例患儿中，37例（24.8%）患儿处于高压力水平。与学龄期患儿相比，青春期患儿压力水平更高，且更多地采用消极应对方式（P < 0.05）。多元线性回归分析结果显示，母亲教育水平为高中及以上患儿以及低压力水平、面对压力采取积极应对的患儿，其糖尿病自我管理水平较高（P < 0.05）。结论 近四分之一的儿童青少年1型糖尿病患儿处于高压力水平。医护人员在对儿童青少年患儿进行糖尿病自我管理教育时，重点人群应放在母亲教育水平为初中及以下水平的家庭；策略方面，应以减压为目标，引导患儿更多地采取积极应对方式缓解压力。     

老年2型糖尿病患者教育和管理领域护理问题的现状及对策探讨

通过对某医院2008-2013年间收治的768例老年2型糖尿病住院患者进行回顾性资料分析,探求近年来老年2型糖尿病患者健康教育和自我管理领域存在的护理问题现状,并针对问题采用以循证为基础的方法结合临床经验及患者实际情况探讨行之有效的健康教育对策,以期为老年2型糖尿病患者健康教育体系的进一步完善和科学发展提供参考。     

朱琏指针点按疗法联合自我管理模式在中风偏瘫患者中的应用研究

目的探讨朱琏指针点按疗法配合自我管理模式对中风偏瘫患者应对疾病和运动功能及日常生活活动能力的影响。方法将200例中风偏瘫患者按入院时间先后顺序随机平分为观察组和对照组,对照组接受卒中单元常规护理,观察组在此基础上实施朱琏指针点按疗法联合自我管理模式。连续干预4周后评价效果。结果干预后观察组MAS、MBI和MCMQ评分显著高于对照组,差异有统计学意义(P0.05)。结论将朱琏指针点按疗法联合自我管理模式运用于中风偏瘫患者,有利于患者建立战胜疾病的信心,自我管理疾病的主观能动性得到充分发挥,有助于帮助患者积极配合临床治疗护理,改善机体运动功能和日常生活活动能力,提高生活质量,促进疾病康复。     

The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

ObjectivesTo evaluate the effectiveness of interventions used to support self-management, and to explore patients’ experiences after acute coronary syndrome in relation to self-management.DesignScoping review.Data sourcesKeyword search of CINAHL Plus, Medline, the Cochrane Library, and PsycINFO databases for studies conducted with adult population and published in English between 1993 and 2014.Review methodsFrom title and abstract review, duplicated articles and obviously irrelevant studies were removed. The full texts of the remaining articles were assessed against the selection criteria. Studies were included if they were original research on: (1) effectiveness of self-management interventions among individuals following acute coronary syndrome; or (2) patients’ experience of self-managing recovery from acute coronary syndrome.Results44 articles (19 quantitative and 25 qualitative) were included. Most studies were conducted in western countries and quantitative studies were UK centric. Self-management interventions tended to be complex and include several components, including education and counselling, goal setting and problem solving skills which were mainly professional-led rather than patient-led. The review demonstrated variation in the effectiveness of self-management interventions in main outcomes assessed – anxiety and depression, quality of life and health behavioural outcomes.For most participants in the qualitative studies, acute coronary syndrome was unexpected and the recovery trajectory was a complex process. Experiences of making adjustment and adopting lifestyle changes following acute coronary syndrome were influenced by subjective life experiences and individual, sociocultural and environmental contexts. Participants’ misunderstandings, misconceptions and confusion about disease processes and management were another influential factor. They emphasised a need for ongoing input and continued support from health professionals in their self-management of rehabilitation and recovery, particularly during the initial recovery period following hospital discharge.ConclusionsEvidence of the effectiveness of self-management interventions among people with acute coronary syndrome remains inconclusive. Findings from the patients’ experiences in relation to self-management following acute coronary syndrome provided important insights into what problems patients might have encountered during self-managing recovery and what support they might need, which can be used to inform the development of self-management interventions. Theoretical or conceptual frameworks have been minimally employed in these studies and should be incorporated in future development and evaluation of self-management interventions as a way of ensuring clarity and consistency related to how interventions are conceptualised, operationalised and empirically studied. Further research is needed to evaluate self-management interventions among people following acute coronary syndrome for sustained effect and within different health care contexts.     

Self-management tasks to improve mobility and reduce fall risk are not leading to lower research participation in older adults

Purpose of studyThe first aim is to evaluate, in a sub-study, the recruitment process of the Senior Step Study, which was an intervention study on the self-management of mobility and fall risk; the second aim is to explore the reasons mentioned by older people, from three different settings, for (not) participating.MethodsSubjects were community-dwelling older persons, residents of homes for the elderly, and older persons regularly visiting community centres. The effectiveness of different recruitment procedures was analysed for each setting separately. We also analysed reasons for accepting and declining participation between the settings.ResultsThe total inclusion rate was 27.9%. A personal initial approach (i.e., first contact was face-to-face or in a group meeting) did not improve the inclusion rate. More subjects consented to participate after an introductory meeting (which was planned after the first face-to-face contact) compared to persons not having one (p < 0.01). At different settings, subjects gave different reasons for participation. No differences were found in the reasons for refusing participation. Especially in homes for the elderly, people refused to participate because the research was too burdensome.ConclusionsThe inclusion rates in this study are comparable to other self-management studies with older people. An introductory meeting during which the study design and benefits of participating are explained and formal interim evaluations of the recruitment process may benefit recruitment. Recruiting older persons for self-management tasks is possible with the appropriate recruitment process, enabling more research on this increasingly important research topic.     

Repeatability and reliability of the diabetic foot self-care questionnaire in Arabic patients: A transcultural adaptation

PurposeThe diabetic foot self-care questionnaire is considered a self-care evaluation tool with 16 questions for assessing diabetic foot health disorders. To date, the DFSQ has been validated in different languages, but an Arabic version was lacking. Consequently, the purpose of this study was to translate and validate the Arabic version of the DFSQ (DFSQ-AR).MethodA suitable method was developed for the translation protocol and cross-cultural validation from Spanish to Arabic. Regarding the total marks from each sub-scale, agreement degrees and confidence were analyzed using Cronbach's α and intraclass correlation coefficient (ICC), respectively. In addition, the mean ± standard deviation differences between pre and post-tests were calculated and completed using Bland-Altman distribution plots.ResultsExcellent agreement between the two versions was demonstrated based on Cronbach's α. Three sub-scales consisting of knowledge of foot hygiene, the appropriate use of footwear and socks, and podiatric self-care were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for the self-care and shoe and socks sub-scales. There were no significant differences among any domains (p > 0.05). There were no statistically significant differences (P = 0.000) for the mean ± standard deviations (SD) between pre- and post-tests (98.09 ± 15.42) [93.75–102.43] and 97.96 ± 13.88 [94.5–101.86] points, respectively). Bland-Altman plots or clinically pertinent variations were not statistically significantly different.ConclusionsThe DFSQ-AR is considered a strong and valid questionnaire with adequate repeatability in the Arabic language population.     

经皮冠状动脉支架植入术后个性化健康教育对提高患者自我管理能力的影响

目的：观察个性化健康教育模式应用于经皮冠状动脉支架植入术( PCI)后患者中对改善其自我管理能力的作用，总结其临床可行性。方法选择在我院2014年6月至2015年6月期间行PCI治疗后的患者60例，分别对其一般资料、疾病资料及健康知识进行调查，收集调查结果进行分类，给予个性化健康教育，观察护理前后患者自我管理能力评分的变化。结果所有患者在实施个性化健康教育后，对该疾病的健康知识认知水平及自我管理能力各维度得分对比干预前，均都有不同程度的改善，(P<0．05)，差异具有统计学意义。结论个性化健康教育模式应用在PCI术后患者中可以明显提高患者对疾病的认知程度，从而提高术后自我管理能力，有重要的临床使用价值。