癌症患者决策辅助工具应用体验质性研究的Meta整合

目的 对成年癌症患者决策辅助工具应用体验进行系统整合,为开发我国本土化决策辅助工具、实现共享决策提供循证指导。方法 计算机检索PubMed、Cochrane Library、CINAHL、Embase、Web of Science、ProQuest、中国知网、万方数据库、维普网、中国生物医学文献数据库中关于癌症患者决策辅助工具应用体验的质性研究,检索时限为建库至2023年7月。采用JBI 循证卫生保健中心质性研究质量评价标准（2020）进行文献质量评价,以Meta整合方法对文献研究结果进行整合。结果 纳入17篇文献,提炼出50个研究结果,归纳出7个类别,最终形成3个整合结果：患者对决策辅助工具总体满意度较高、增强患者决策参与体验、阻碍因素。结论 决策辅助工具可以帮助癌症患者了解治疗方案并积极参与决策,满足患者的决策需求,缓解决策冲突,从而改善患者的临床结局。     

儿童和青少年癌症患者终末期真实体验与需求的Meta整合

目的 对儿童和青少年癌症患者终末期真实体验与需求的质性研究结果进行整合,为更好地开展安宁疗护实践提供参考。方法系统检索中英文数据库关于儿童和青少年癌症患者终末期真实体验与需求的质性研究,检索时限从建库至2023年4月1日。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准进行文献质量评价,采用汇集整合法进行Meta整合。结果共纳入8篇研究,质量等级均为B级。提炼出40个研究结果,将相似结果归纳组合形成 7个新的类别,并整合为3个结果：遭受身心痛苦体验;积极应对疾病,经历正面心理体验及自身成长;对正常生活的渴望,希望得到社会支持。结论儿童和青少年癌症患者终末期经历消极和积极体验,其需求有年龄差异性。医护人员需重视儿童和青少年癌症患者终末期体验和需求,提供心理疏导和必要支持,提升其终末期生活质量。     

癌症患者诊断知情心理体验质性研究的Meta整合

目的 系统评价癌症患者诊断知情心理体验,为临床制订更全面和更有针对性的疾病告知方式提供参考.方法 计算机检索PubMed、The Cochrane Library、Medline、中国知网、万方数据等数据库,检索癌症患者诊断知情心理体验质性研究文献,检索时限为建库至2020年12月,采用质性研究质量评价标准进行文献质量评价,并对文献进行Meta整合.结果 纳入18项研究,将文献提炼出的62个主题归纳成12个新的类别,综合成3个整合结果,即多重因素影响癌症患者对诊断的接受度、诊断告知方式方法、获悉患病信息后的改变.结论 癌症患者诊断知情的开展受多种因素影响,不同患者获知疾病诊断后的反应不同.医护务人员开展疾病告知前应充分做好评估,选择适宜的病情告知模式,减少患者获知疾病诊断所致的伤害.     

女性终末期肾病患者疾病体验质性研究的Meta整合

目的 系统整合女性终末期肾病患者疾病体验，为医护人员优化过渡期护理，改善患者生活质量提供参考。 方法 计算机检索PsycINFO、PubMed、Embase、CINAHL和中国知网、中国生物医学文献数据库、万方数据库，收集关于女性终末期肾病患者疾病体验的质性研究，检索时限为建库至2022年12月。运用JBI质性研究质量评价标准评价纳入文献的质量，采用汇集性整合方法对结果进行整合。 结果 共纳入8篇文献，提炼出28个完好明确的研究结果，将相似结果归纳为8个新的类别，并综合成3个整合结果：过渡期疾病体验、女性角色功能受损、妊娠风险决策。 结论 医护人员应重视女性终末期肾病患者疾病体验，优化过渡期护理，提升患者角色适应水平，改善育龄期患者妊娠决策辅助，最终提升患者长期生活质量。     

肿瘤患者味觉改变体验及应对质性研究的Meta整合

目的 系统评价肿瘤患者味觉改变体验及应对的质性研究,为制订针对性干预方案提供参考。 方法 计算机检索PubMed、CINAHL、Web of Science、Embase、Scopus、ProQuest、中国知网、万方数据等数据库中有关肿瘤患者味觉改变体验及应对的质性研究,检索时限为建库至2022年4月。采用JBI循证卫生保健中心的质性研究质量评价标准进行文献质量评价,采取汇集性整合方法整合研究结果。 结果 纳入14篇文献,提炼出69个主题,归纳成5个类别,综合形成味觉改变体验的复杂多变、多元化的管理策略2个整合结果。 结论 肿瘤患者味觉改变复杂多变,负面影响患者的生活。护士应关注肿瘤患者味觉改变体验,给予持续、动态评估,加强健康教育,协助患者提高症状管理自我效能,提升味觉改变管理能力。     

癌症患者抚养未成年子女体验质性研究的Meta整合

目的 探讨癌症患者抚养未成年子女的感受,为临床改善患者心理体验提供参考。 方法 检索国内外数据库中有关癌症患者抚养未成年子女真实体验的质性研究文献,检索时限为建库至2022年10月,采用Meta整合方法对研究结果进行整合归纳。 结果 共纳入12项研究,提炼52个结果,归纳后形成13个类别,整合成4个结果：癌症患者抚养未成年子女情感体验复杂、癌症患者育儿的担忧和挑战、癌症患者适应双重角色并有所收获、癌症患者抚养未成年子女的过程中有多方面的养育需求。 结论 患癌父母育儿体验复杂,心理压力较大,渴望得到帮助。医护人员应重视该群体的特殊需求,并制定针对性护理支持,减轻患者心理压力和负担。     

成批伤员医院内急救护士参与体验质性研究的系统评价

目的系统评价成批伤病员院内急救过程中护士的救护体验。方法计算机检索从建库至2017年10月Cochrane Library、JBI循证卫生保健中心图书馆、MEDLINE、EMbase、Web of Science、Scopus、CINAHL、PsycINFO、CBM、CNKI和万方数据库关于成批伤病员医院内急救阶段护士参与救治体验相关的质性研究文献。使用JBI循证卫生保健中心质性研究质量评价标准对文献进行评价,采用汇集性整合方法对结果进行整合。结果纳入12项研究,提炼出46个明确的研究结果,归纳组合形成5个新的类别,并综合成2个整合结果:医院面对成批伤亡事件产生的不利状况使护士产生复杂的心理体验及需求;医院应当采取有效应对成批伤员的方法,同时提升护士的应对能力。结论为更加高效地救治成批伤员,医院管理层应当关注护士的心理状态和需求,采取合理的成批伤急救应对策略和培养护士的专业应对能力。     

国内肾移植术后患者心理体验的质性Meta整合

目的系统评价肾移植患者术后心理体验。方法计算机检索数据库中国知网、万方数据库、维普数据库、中国生物医学文献数据库,搜索关于肾移植患者术后真实体验的质性研究,检索时限从建库至2018年5月。进行文献质量评价后,采用Meta整合方法对研究结果进行归纳、诠释。结果共纳入8篇文献,提炼出52个结果、6个类别和3个整合结果,分别为肾移植术后患者消极心理、肾移植术后患者对未来与生命的心理感受、肾移植术后患者的自身健康需求与期望。结论医护人员应充分了解肾移植术后患者心理体验,做好针对性心理干预,引导患者调整认知和行为方式,提高患者的术后生活质量,并且增强患者对未来生活的心理资本。     

女性压力性尿失禁患病体验质性研究的Meta整合

目的 对压力性尿失禁女性患者患病体验进行整合,为临床医护人员实施积极心理照护提供循证依据。方法 计算机检索The Cochrane Library、PubMed、EMbase、Web of Science、OVID、CINAHL、中国知网、万方数据库、维普数据库、中国生物医学数据库,检索年限从建库至2022年1月。采用澳大利亚JBI循证卫生中心的质性研究真实性评价工具(2016版)对文献质量进行评价,采用汇集性整合方法对结果进行分析。结果 纳入的10篇文献提炼30个研究结果,将相似结果归纳总结形成6个新的类别,最后综合成2个整合结果：压力性尿失禁让患者丧失对身体的控制,造成生理障碍,产生自我否定、混乱、隔离等负性情绪;压力性尿失禁患者对自身症状知晓程度滞后,渴望外界主动关注,足够的社会支持帮助其自我管理。结论 尿失禁给女性患者带来较大身心困扰,一方面,患者应提高自我管理与心理认知水平,积极融入社会生活;另一方面,医护人员应注重患者的心理变化,向患者及家属普及尿失禁相关知识,增强社会及家庭支持,以提高患者生活质量。     

脊髓损伤患者创伤后成长体验质性研究的Meta整合

目的 对脊髓损伤患者创伤后成长体验的质性研究进行系统评价和Meta整合。 方法 计算机检索PubMed、Cochrane图书馆、Web of Science、中国知网（CNKI）、万方数据库、维普网、中国生物医学文献服务系统（SinoMed）等国内外数据库中关于脊髓损伤患者创伤后成长真实心理体验的质性研究文献。检索时限均为建库至2018年12月。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准（2016）对文献进行评价,并采用汇集性整合方法对结果进行整合与分析。结果 综合分析后形成3个整合结果：脊髓损伤患者创伤后成长历程曲折,需要经历绝望中的挣扎、对自我存在意义的反思获得成长;个人资源、认知加工、参加有意义的活动和社会支持都是脊髓损伤患者创伤后成长的保护性因素;脊髓损伤患者在认知行为层面的应对策略。结论 医护人员、家属及社会应相互协作,挖掘患者个人有利资源,采取干预措施,提高患者创伤后成长水平,使其积极面对疾病及生活,力争早日重返社会。     

住院患者人文关怀体验质性研究的系统评价

目的系统评价普通住院患者对人文关怀的感知体验,为临床开展人文关怀护理提供参考。方法计算机检索PubMed、Ovid(Embase)、EBSCO(CINAHL、PsycINFO)、Science Direct、Web of Science、CBM、中国知网(CNKI)、万方数据库、维普网(VIP),收集普通住院患者人文关怀体验的质性研究,检索时限为建库至2020年2月28日。采用2016年澳大利亚JBI循证卫生保健中心质性研究评价标准进行评价,对符合纳入标准的文献进行整合。结果共纳入13篇文献,提炼出67个明确的研究结果,归纳出6个新的类别,得到2个整合结果:关注患者外在/直接/生理需求的感知和回应,能增强患者人文关怀体验;注重对患者内在/间接/心理需求的感知和回应,能稳固患者人文关怀体验。结论住院患者对人文关怀的感知体验涉及多个方面,护理人员应采取个性化且有针对性的护理措施,满足患者对人文关怀的多层次需求。     

Prostate Cancer Screening Patterns Among Sexual and Gender Minority Individuals

One in six gay and bisexual men will be diagnosed with prostate cancer in their lifetime. Lesbian, gay, bisexual, and transgender (LGBT) populations are under-represented in cancer research, and guidelines on prostate-specific antigen (PSA) screening are limited. We performed a cross-sectional study to assess patterns of PSA screening and decision-making in this cohort. The Behavioral Risk Factor Surveillance System database was queried for LGBT adults for 2014–2016 and 2018, when PSA questions were asked in the annual survey. Multivariable logistic regression was performed to evaluate the association of LGBT status with PSA screening and informed and shared decision-making. A total of 164 370 participants were eligible for PSA screening, representing a weighted estimate of 1.2 million LGBT individuals. Compared to cisgender (CG) straight individuals, CG gay/bisexual cohorts were more likely to participate in PSA screening (CG gay: odds ratio [OR] 1.07; p < 0.001; CG bisexual: OR 1.06; p < 0.001). CG gay participants were more likely to make informed decisions (OR 1.10; p < 0.001) and engage in shared decision-making (OR 2.55; p < 0.001). Select gay populations were more likely to undergo PSA screening recommended by their clinicians and participate in informed and shared decision-making.Patient summaryThis large study of sexual and gender minorities in the USA suggests that gay and bisexual individuals were more likely to undergo prostate cancer screening and that select gay individuals were more likely to make informed and shared decisions. However, transgender individuals were less likely to have prostate cancer screening and make informed decisions.     

Non-pharmacological nursing interventions for procedural pain relief in adults with burns: a systematic literature review

Adult burn patients experience pain during wound care despite pharmacological interventions. Additional nursing interventions are needed to improve pain management. A systematic review was undertaken in order to examine the implications of previous research for evidence based decisions concerning the use of non-pharmacological nursing interventions and for future research. Twenty-six studies met the inclusion criteria and were discussed. The majority of the included studies concerned behavioural nursing interventions and focussed on promotion of psychological comfort. Although 17 studies showed that the intervention had a positive effect on pain outcomes and no adverse effects of the reviewed interventions were reported, the best available evidence was found for active hypnosis, rapid induction analgesia and distraction relaxation. However, in order to reduce methodological limitations, further research is needed before well-founded evidence based decisions for nursing practice can be made. Aspects that seem important for future research, like the type of the intervention, theoretical framework, manner of giving instruction and guidance, cost, outcomes, measurement instruments and data collection points are considered.     

移动医疗用于脑卒中患者居家康复的范围综述

目的 对移动医疗在脑卒中患者居家康复中应用的研究进行范围审查，识别移动医疗的要素及应用效果，为未来脑卒中患者居家康复的实践提供参考。方法 以范围综述指南为方法学框架，检索PubMed、Embase、CINAHL、Web of Science、Cochrane Library、Scopus、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中移动医疗在脑卒中患者居家康复中应用的相关研究。检索时限为建库至2023年3月20日。对纳入文献进行汇总和分析。结果 共纳入18篇文献，包含13篇随机对照试验和5篇类实验研究。移动医疗在脑卒中患者居家康复中应用的类型主要有应用程序、可穿戴设备、远程康复系统、网络信息化平台及社交媒体；居家康复内容涉及运动功能康复、语言功能康复、吞咽功能康复及心理康复；结局指标包括康复效果指标、生活质量、自我管理及患者体验。结论 移动医疗在脑卒中患者居家康复中的应用可行，且具有积极效果。未来应探索合适的脑卒中患者居家康复服务规范，在多学科团队协作的基础上，开发出具有专业性及普适性的移动医疗设备，提升移动医疗在脑卒中患者居家康复中应用的质量。     

移动医疗用于脑卒中患者居家康复的范围综述

目的 对移动医疗在脑卒中患者居家康复中应用的研究进行范围审查，识别移动医疗的要素及应用效果，为未来脑卒中患者居家康复的实践提供参考。 方法 以范围综述指南为方法学框架，检索PubMed、Embase、CINAHL、Web of Science、Cochrane Library、Scopus、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中移动医疗在脑卒中患者居家康复中应用的相关研究。检索时限为建库至2023年3月20日。对纳入文献进行汇总和分析。 结果 共纳入18篇文献，包含13篇随机对照试验和5篇类实验研究。移动医疗在脑卒中患者居家康复中应用的类型主要有应用程序、可穿戴设备、远程康复系统、网络信息化平台及社交媒体；居家康复内容涉及运动功能康复、语言功能康复、吞咽功能康复及心理康复；结局指标包括康复效果指标、生活质量、自我管理及患者体验。 结论 移动医疗在脑卒中患者居家康复中的应用可行，且具有积极效果。未来应探索合适的脑卒中患者居家康复服务规范，在多学科团队协作的基础上，开发出具有专业性及普适性的移动医疗设备，提升移动医疗在脑卒中患者居家康复中应用的质量。     

心力衰竭患者症状管理质性研究的系统评价

目的系统评价心力衰竭患者自我症状管理的真实体验。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、CINAHL、PsycINFO以及中国生物医学文献服务系统、中国知网、万方数据、维普数据库从建库至2020年8月相关的质性研究。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准评价纳入文献,运用Meta整合方法对结果进行整合。结果共纳入10篇质性研究,提炼出33个完整的研究结果,归纳出9个新的类别,得到2个整合结果:患者对所经历症状的感知和理解;患者形成了适合自己的症状管理方式。结论心力衰竭患者在与症状共存过程中通过对症状的观察和监测,不断积累症状管理经验,获得了自我成长,但患者在症状管理过程中仍欠缺知识及心理方面的支持,医护人员需针对患者症状管理中的薄弱环节,进一步完善症状管理的干预策略,提高患者的症状管理能力。     

Responding to Trust: Surgeons’ Perspective on Informed Consent

Background  Every day thousands of surgeons and patients negotiate their way through the complex process of decision-making about operative treatments. We conducted a series of qualitative studies, asking patients and surgeons to describe their experience and beliefs about informed decision-making and consent. This study focuses on surgeons’ views. Methods  Open-ended interviews and focus group discussions were conducted with thoracic surgeons who treated esophageal cancer patients by esophagectomy, and general surgeons who routinely performed laparoscopic cholecystectomy. Their views were analyzed using a qualitative approach, grounded in the perspectives of the participants. Results  Five dominant themes emerged from the analysis: (1) making informed decisions; (2) communicating information and confidence; (3) managing expectations and fears; (4) consent as a decision to trust; (5) commitment inspired by trust. These themes are illustrated by verbatim quotes from the surgeon interviews. Conclusions  Surgeons carefully assess the risks and benefits of treatment before consenting to perform operative interventions. They are influenced by objective findings and by affective factors such as courage and the determination to survive expressed by their patients. They manage risks, doubts, and fears—both their patients’ and their own—relying on trust and commitment on both sides to ensure the success of the surgical mission. The trust of their patients has a strong influence on the surgeons’ decisions and actions.     

A prospective analysis of implementation of multi-disciplinary team decisions in breast cancer

Multi-disciplinary teams (MDTs) management of patients with cancer is mandatory in the United Kingdom, and auditing team decision-making by examining rates of decision implementation and reasons for nonimplementation may inform this practice. Consecutive breast cancer MDT decisions, subsequent decision implementation, and reasons for nonimplementation were prospectively recorded. Factors associated with nonimplementation of the MDT decision were analyzed with logistic regression. Of 289 consecutive MDT decisions involving 210 women, 20 (6.9%, 95% CIs 4.3%-10.5%) were not implemented. Most changed MDT decisions did so because of patient preferences (n = 13, 65%), with the discovery of new clinical information (n = 3) and individual doctor's views (n = 4) also leading to decision nonimplementation. MDT decisions were significantly less likely to be adhered to in patients with confirmed malignant disease compared to those with benign or 'unknown' disease categories (p < 0.001) and MDT decisions in older patients were significantly more likely not to be implemented than in younger patients (p = 0.002). Auditing nonimplementation of MDT recommendations and examining reasons for changed decisions is a useful process to monitor team performance and to identify factors that need more attention during the MDT meeting to ensure that the process makes optimal patient centered decisions.     

Patients' preferences for communicating a prostate cancer diagnosis and participating in medical decision-making

OBJECTIVES: To assess patients' preferences about how physicians' deliver news of a prostate cancer diagnosis, and patients' preferred participation in medical decision-making, with a secondary objective being to validate the Measure of Patients' Preferences (MPP) scale with these patients. PATIENTS AND METHODS: Eighty-seven men (mean age 62.4 years) referred to an ultrasound/radiology department for their first transrectal ultrasonography (TRUS)-guided biopsy completed the MPP and Control Preferences measures. Patients were asked to identify how they would like to be told about a potential prostate cancer diagnosis by their physician, and what role they would like in making treatment-related decisions with their physicians. RESULTS: Most patients wanted either an active (43%) or collaborative (47%) role in medical decision-making if the TRUS showed prostate cancer. Men rated content items (what and how much information is provided by their physician) as more important than supportive (emotional support during interaction) or facilitative (setting and context variables) items. Men who preferred a collaborative role in the patient-physician interaction wanted significantly (P = 0.04) more content (detailed information on available treatments and the effect of these treatments on their quality of life) than men who had a preference for either an active or passive role in medical decision-making. Demographic characteristics were not indicative of either preferred role in decision-making or communication preferences. The MPP was shown to be reliable. CONCLUSIONS: Men have expectations about how physicians disclose a diagnosis of prostate cancer and how they wish to participate in making treatment decisions. These results underline the importance of identifying patient preferences before embarking on treatment discussions, as the way 'bad news' is disclosed has previously been identified as a predictor of the outcome of the patient-physician interview.