中国全科医学 ›› 2023, Vol. 26 ›› Issue (12): 1503-1512.DOI: 10.12114/j.issn.1007-9572.2022.0649

• 医学循证 • 上一篇    下一篇

正念减压疗法可改善乳腺癌患者心理状况:基于系统评价再评价

郑卿勇1, 赵亮1, 隗伟2, 任雪君2, 王超2, 孙瑞2, 丛明华2, 于雷2, 杨敏2,*()   

  1. 1730000 甘肃省兰州市,兰州大学护理学院兰州大学循证护理中心
    2100021 北京市,国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院综合科
  • 收稿日期:2022-08-10 修回日期:2022-10-25 出版日期:2023-04-20 发布日期:2022-11-30
  • 通讯作者: 杨敏

  • 作者贡献:郑卿勇与杨敏提出了研究选题方向,负责文章的构思、设计、分析与报告;赵亮、隗伟负责数据整理与图表制作;任雪君、王超、孙瑞与丛明华负责文献筛选、数据提取与质量评价;郑卿勇撰写了文章初稿;于雷负责统计学指导与语言文字润色;杨敏负责论文的质量控制和审校,对文章整体负责;所有作者对稿件进行了严格的审阅与修改。
  • 基金资助:
    中央高校基本科研业务费专项资金资助(3332020027)

Mindfulness-based Stress Reduction Can Improve Psychological Condition in Breast Cancer Patients: an Overview of Systematic Reviews

ZHENG Qingyong1, ZHAO Liang1, WEI Wei2, REN Xuejun2, WANG Chao2, SUN Rui2, CONG Minghua2, YU Lei2, YANG Min2,*()   

  1. 1School of Nursing/Evidence-Based Nursing Center, Lanzhou University, Lanzhou 730000, China
    2Department of Comprehensive Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2022-08-10 Revised:2022-10-25 Published:2023-04-20 Online:2022-11-30
  • Contact: YANG Min

摘要: 背景 乳腺癌已成为全球第一大癌种,其治疗与康复过程往往给患者带来严重的心理困扰。诸多系统评价(SR)发现正念减压疗法(MBSR)在乳腺癌患者心理照护方面有一定效果,但不同SR结局指标差异明显,不能直接应用于临床。 目的 对MBSR在乳腺癌患者中应用效果的SR进行再评价,从而为乳腺癌患者的心理照护提供决策参考。 方法 系统检索PubMed、Embase、Cochrane Library、Web of Science、CINAHL、PsycINFO、JBI,中国知网、万方数据知识服务平台及中国生物医学文献数据库关于MBSR在乳腺癌患者心理干预应用效用的SR,检索时间为建库至2022年7月。2位研究者对文献进行筛选后提取研究相关信息,分别应用系统评价方法学质量评价工具2(AMSTAR 2)量表、系统综述和荟萃分析优先报告的条目(PRISMA)声明、证据质量与推荐强度分级(GRADE)及定性系统评价证据分级(CERQual)进行方法学质量、报告规范及证据质量评估。 结果 共纳入14篇SR。AMSTAR 2结果显示整体方法学质量不高,仅有1篇为高质量研究,2项关键条目信息严重缺失。PRISMA声明显示报告质量缺陷主要在研究方案注册、研究间偏倚风险评估及资金来源方面。14篇SR共包括15项结局指标及73个证据体;GRADE分级结果显示,无高级别证据,31个中级证据,28个低级证据,6个极低级证据;CERQual分级结果显示,8个低级证据。MBSR能够不同程度地改善乳腺癌患者焦虑、抑郁、疲乏及压力等,且短期疗效明显,但长期疗效尚不确定。 结论 目前关于MBSR在乳腺癌患者中应用效果的SR证据质量整体水平不高,研究的方法学质量及报告规范程度均有待进一步提高,研究显示MBSR可短期改善乳腺癌患者心理状况,长期效果不确定,但仍需要更多高质量、大样本的研究以进一步验证。

关键词: 乳腺肿瘤, 正念, 认知行为疗法, 系统评价再评价, 生活质量, 方法学, AMSTAR 2, GRADE

Abstract:

Background

Worldwide, breast cancer has become the most common malignancy, and many breast cancer survivors struggle with psychological problems in treatment and recovery. The efficacy of mindfulness-based stress reduction (MBSR) in the psychological care of breast cancer patients has been confirmed in many systematic reviews (SRs) . However, due to inconsistent outcome measures used in various SRs, the review results cannot be directly applied to clinical practice.

Objective

To perform an overview of the SRs of the efficacy of MBSR in breast cancer patients, providing a reference for the making of psychological care interventions for these patients.

Methods

PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, JBI, CNKI, Wanfang Data, and CBM were searched from inception to July 2022 for SRs of patients with breast cancer treated with MBSR. Literature screening and data extraction were performed by two researchers independently. Methodological quality was assessed using the AMSTAR 2. The standardization of reporting quality was assessed using the PRISMA checklist. Quality of evidence and strength of recommendations were assessed using the GRADE approach. The confidence of evidence from qualitative SRs was assessed using the CERQual.

Results

Fourteen SRs were included. The methodological quality of included SRs was generally low, with only one being of high quality and two fatally missing key items. The defects in reporting quality were mainly in study protocol registration, risk of bias assessment and funding sources. Fifteen outcomes and 73 evidence bodies (0, 31, 28 and 6 were classified as high, moderate, low, and very low quality, respectively, by the GRADE approach, and the other 8 were classified as low quality by the CERQual approach) were identified in the SRs in total. MBSR could relieve anxiety, depression, fatigue, and stress in breast cancer patients to varying degrees, whose efficacy has proven to be significant in a short-term, but is uncertain in a long-term.

Conclusion

Generally, SRs on MBSR improving psychological condition in breast cancer patients contain unsatisfactory quality of evidence, whose methodological quality and standardization level of reporting quality still need to be improved further. Moreover, the shorter-term effect of MBSR has been confirmed, but its long-term effect is uncertain, and requires to be evaluated by more high-quality, large-sample clinical studies.

Key words: Breast neoplasms, Mindfulness, Cognitive behavioral therapy, Overview of systematic reviews, Quality of life, Methods, AMSTAR 2, GRADE