接纳与承诺疗法对癌症患者心理健康和生活质量影响的meta分析

doi:10.3969/j.issn.1004-583X.2024.02.001

摘要/Abstract

摘要：

目的系统评价接纳与承诺疗法(acceptance and commitment therapy,ACT)对癌症患者心理健康和生活质量的影响。方法检索建库至2022年11月在CBM、万方、知网、维普、PubMed、Cochrane Library、Web of Science、EMbase数据库发表的有关ACT对癌症患者心理健康和生活质量影响的随机对照试验。由2名研究者根据纳入及排除标准独立筛选文献、质量评价并提取数据,采用RevMan 5.4进行meta分析。结果共纳入14篇文献,1 063例癌症患者。Meta分析结果显示,ACT在改善癌症患者的焦虑[SMD=-1.04,95%CI (-1.19,-0.89),P<0.01]、抑郁情绪[SMD=-0.73,95%CI(-0.88,-0.59),P<0.01], 提升心理灵活性[MD=-2.17,95%CI (-2.77,-1.57),P<0.01]及生活质量[MD=5.27,95%CI(3.57,6.98),P<0.01]方面差异具有统计学意义。结论 ACT有助于缓解癌症患者的焦虑及抑郁情绪, 提升心理灵活性及生活质量, 对促进癌症患者的心理健康和生活质量具有积极作用。

关键词: 接纳与承诺疗法, 癌症, 心理护理, meta分析

Abstract:

Objective To systematically evaluate the effect of acceptance and commitment therapy (ACT) on the mental health and quality of life of cancer patients. Methods Randomized clinical trials (RCTs) reporting the influence of ACT on mental health and quality of life in cancer patients were searched in the CBM, WanFang, CNKI, VIP, PubMed, Cochrane Library, Web of Science and EMbase databases, and the retrieval time was from the time of building the database to November 2022. Literature screening based on inclusion and exclusion criteria, quality assessment and data extraction were performed by two investigators. A meta-analysis was conducted using Revman5.4 software. Results A total of 14 RCTs representing 1,063 cancer patients were enrolled. Meta-analysis results showed that ACT significantly improved anxiety (SMD=-1.04, 95%CI [-1.19, -0.89], P<0.01), depression (SMD=-0.73, 95%CI[ -0.88, -0.59], P<0.01), psychological flexibility (MD=-2.17, 95%CI[-2.77, -1.57], P<0.01) and quality of life in cancer patients (MD=5.27, 95%CI [3.57, 6.98], P<0.01). Conclusion ACT can relieve anxiety and depression, improve psychological flexibility and quality of life, and positively promoting physical and mental health of cancer patients.

Key words: acceptance and commitment therapy, cancer, psychological nursing, meta-analysis

中图分类号:

R473.73

龚财芳, 赵俊宇, 游川. 接纳与承诺疗法对癌症患者心理健康和生活质量影响的meta分析[J]. 临床荟萃, 2024, 39(2): 101-107.

Gong Caifang, Zhao Junyu, You Chuan. Effect of acceptance and commitment therapy on mental health and quality of life in cancer patients: A meta-analysis[J]. Clinical Focus, 2024, 39(2): 101-107.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.02.001

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I2/101

图/表 9

参考文献 37

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71 (3): 209-249. doi: 10.3322/caac.v71.3 URL
[2]	王思颖, 郑幸玲, 覃文新. 癌症患者能否长期生存?[J]. 上海交通大学学报, 2021, 55(z1):49-50.
[3]	贾莉莉, 朱康宁, 张国增, 等. 癌症患者疾病感知的研究进展[J]. 中华护理教育, 2020, 17 (8):765-768.
[4]	Huda N, Shaw MK, Chang HJ. Psychological distress among patients with advanced cancer: A conceptual analysis[J]. Cancer Nurs, 2022, 45 (2):E487-E503. doi: 10.1097/NCC.0000000000000940 URL
[5]	Burhan HŞ, Karadere E. Effectiveness of acceptance and commitment therapy for patients with psychosis being monitored at a community mental health center: A six-month follow-up study[J]. Alpha Psychiatry, 2021, 22 (4): 206-211. doi: 10.5455/apd.93130 pmid: 36424936
[6]	Esmali A, Alizadeh M. The effectiveness of group psychotherapy based on acceptance and commitment on increasing of mental health and the quality of women’s life with breast cancer[J]. Biosci Biotechnol Res Asia, 2015, 12 (3): 2253-2260. doi: 10.13005/bbra/ URL
[7]	Hayes SC, Luoma JB, Bond FW, et al. Acceptance and commitment therapy: Model, processes and outcomes[J]. Behav Res Ther, 2006, 44 (1): 1-25. doi: 10.1016/j.brat.2005.06.006 pmid: 16300724
[8]	Yıldız E. The effects of acceptance and commitment therapy in psychosis treatment: A systematic review of randomized controlled trials[J]. Perspect Psychiatr C, 2019, 56 (1):149-167.
[9]	Sakamoto R, Ohtake Y, Kataoka Y, et al. Efficacy of acceptance and commitment therapy for people with type 2 diabetes: Systematic review and meta-analysis[J]. J Diabetes Invest, 2021, 13 (2): 262-270. doi: 10.1111/jdi.13658 pmid: 34486816
[10]	Ghorbani V, Zanjani Z, Omidi A, et al. Efficacy of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer: A pre- and post-test clinical trial[J]. Trends Psychiatry Psychother, 2021, 43(2):126-133. doi: 10.47626/2237-6089-2020-0022 pmid: 34392667
[11]	Shari NI, Zainal NZ, Ng CG. Effects of brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy[J]. J Psychosoc Oncol, 2020, 39 (6):695-714. doi: 10.1080/07347332.2020.1856283 URL
[12]	Serfaty M, Armstrong M, Vickerstaff V, et al. Acceptance and commitment therapy for adults with advanced cancer (CanACT): A feasibility randomised controlled trial[J]. Psycho Oncology, 2018, 28 (3):488-496. doi: 10.1002/pon.v28.3 URL
[13]	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version5.1.0[M]. London: The Cochrane Collaboration, 2011:150-151.
[14]	Fernández-Rodríguez C, González-Fernández S, Coto-lesmes R, et al. Behavioral activation and acceptance and commitment therapy in the treatment of anxiety and depression in cancer survivors: A randomized clinical trial[J]. Behav Modif, 2020, 45 (5):822-859. doi: 10.1177/0145445520916441 URL
[15]	González-Fernández S, Fernández-Rodríguez C, Paz-Caballero M, et al. Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy[J]. Psicothema, 2018, 30 (1):14-20. doi: 10.7334/psicothema2017.396 pmid: 29363465
[16]	Johns SA, Stutz PV, Talib TL, et al. Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial[J]. Cancer Am Cancer Soc, 2019, 126 (1):211-218.
[17]	Li H, Jin X, Ng M, et al. Effects of Acceptance and commitment therapy on fatigue interference and health-related quality of life among patients with advanced lung cancer: A pilot randomized controlled trial[J]. Asia Pac J Oncol Nur, 2022, 9 (8):100102.
[18]	Mohabbat-Bahar S, Maleki-Rizi F, Akbari ME, et al. Effectiveness of group training based on acceptance and commitment therapy on anxiety and depression of women with breast cancer[J]. Iran J Cancer Prev, 2015, 8 (2):71-6.
[19]	周小帅. 接纳与承诺疗法在乳腺癌根治术后患者护理中的应用效果[J]. 中国民康医学, 2020, 32(11):151-153.
[20]	姚晚侠, 何苗, 李春华, 等. 接纳与承诺疗法在乳腺癌术后化疗患者中的应用及效果观察[J]. 护士进修杂志, 2020, 35(24):2275-2277.
[21]	潘虹, 罗冰, 遆甜, 等. 接受与承诺疗法对晚期胰腺癌病人心理应激的影响[J]. 护理研究, 2020, 34(7):1279-1282.
[22]	王婷婷, 杨孝苹. 接纳与承诺疗法对食管癌术后患者负性情绪及生活质量的影响[J]. 中国临床护理, 2022, 14(2):90-93. doi: 10.3969/j.issn.1674-3768.2022.02.006
[23]	胡迎冬, 蒋维连. 接纳与承诺疗法对乳腺癌术后患者焦虑抑郁情绪及生命质量的影响[J]. 中国实用护理杂志, 2016, 32(29):2265-2268.
[24]	许湘华, 欧美军, 谢婵娟, 等. 接纳与承诺疗法在喉癌术后患者中的应用效果[J]. 解放军护理杂志, 2019, 36(5):6-10.
[25]	魏慧, 薛晓红, 刘梅红. 接纳与承诺疗法对直肠癌患者疼痛及负性情绪的影响[J]. 癌症进展, 2020, 18(23):2472-2475.
[26]	Chinh K, Mosher CE, Brown LF, et al. Psychological processes and symptom outcomes in mindfulness-based stress reduction for cancer survivors: A pilot study[J]. Mindfulness, 2020, 11 (4): 905-916. doi: 10.1007/s12671-019-01299-0 pmid: 33456623
[27]	陶元玲, 孙丽, 张立力. 晚期癌症患者灵性应对现状及影响因素研究[J]. 护理管理杂志, 2022, 22(2):105-110.
[28]	Mitchell AJ, Ferguson DW, Gill J, et al. Depression and anxiety in long- term cancer survivors compared with spouses and healthy controls: A systematic review and meta-analysis[J]. Lancet Oncol, 2013, 14 (8):721-32. doi: 10.1016/S1470-2045(13)70244-4 pmid: 23759376
[29]	Walker J, Magill N, Mulick A, et al. Different independent associations of depression and anxiety with survival in patients with cancer[J]. J Psychosom Res, 2020, 138 110218. doi: 10.1016/j.jpsychores.2020.110218 URL
[30]	Wersebe H, Lieb R, Meyer AH, et al. The link between stress, well-being, and psychological flexibility during an acceptance and commitment therapy self-help intervention[J]. Int J Clin Hlth Psyc, 2017, 18 (1):60-68.
[31]	Lv J, Zhu L, Wu X, et al. Study on the correlation between postoperative mental flexibility, negative emotions, and quality of life in patients with thyroid cancer[J]. Gland Surg, 2021, 10 (8):2471-2476. doi: 10.21037/gs-21-424 pmid: 34527559
[32]	Li H, Wu J, Ni Q, et al. Systematic review and meta-analysis of effectiveness of acceptance and commitment therapy in patients with breast cancer[J]. Nurs Res, 2021, 70 (4):E152-E160. doi: 10.1097/NNR.0000000000000499 pmid: 33492055
[33]	Twohig MP, Levin ME. Acceptance and commitment therapy as a treatment for anxiety and depression: A review[J]. Psychiat Clin N Am, 2017, 40 (4):751-770. doi: 10.1016/j.psc.2017.08.009 URL
[34]	Yu L, Mccracken LM. Model and processes of acceptance and commitment therapy (ACT) for chronic pain including a closer look at the self[J]. Curr Pain Headache R, 2016, 20(2):12. doi: 10.1007/s11916-016-0541-4 pmid: 26803836
[35]	Coto-Lesmes R, Fernández-Rodríguez C, González-Fernández S. Acceptance and commitment therapy in group format for anxiety and depression: A systematic review[J]. J Affect Disorders, 2019, 263: 107-120. doi: 10.1016/j.jad.2019.11.154 URL
[36]	Bai Z, Luo S, Zhang L, et al. Acceptance and commitment therapy (ACT) to reduce depression: A systematic review and meta-analysis[J]. J Affect Disorders, 2019, 260:728-737. doi: 10.1016/j.jad.2019.09.040 URL
[37]	Zhao C, Lai L, Zhang L, et al. The effects of acceptance and commitment therapy on the psychological and physical outcomes among cancer patients: A meta-analysis with trial sequential analysis[J]. J Psychosom Res, 2020, 140 110304. doi: 10.1016/j.jpsychores.2020.110304 URL

纳入文献	年份 (年)	癌症类型	样本量(例)		干预措施		干预时间及方式	结局指标	测量工具
纳入文献	年份 (年)	癌症类型	观察组	对照组	观察组	对照组	干预时间及方式	结局指标	测量工具
Shari等^[11]	2020	乳腺癌	30	30	ACT	常规护理	12周,1次/3周,1 h/次,面对面	①②③	HADS、AAQ-Ⅱ
Serfaty等^[12]	2018	各种类型	20	22	ACT+TC	TC	3月,8次/周,1 h/次,面对面	③④	HADS、FACT
Fernández-Rodríguez等^[14]	2020	各种类型	12	17	ACT	常规护理	3月,12次/周,90 min/次,面对面	①②③	HADS、AAQ-Ⅱ
González-Fernández等^[15]	2018	乳腺癌	12	23	ACT	常规护理	12次/周,90 min/次,面对面	①②③	HADS、AAQ-Ⅱ
Johns等^[16]	2019	乳腺癌	31	31	ACT	SE	6周, 1次/7d, 2 h/次,面对面	①②	GAD、PHQ
Li等^[17]	2022	肺癌	20	20	ACT	常规护理	1次/周,60~90 min/次,面对面+网络视频	①②④	GAD、PHQ
Mohabbat-Bahar等^[18]	2015	乳腺癌	15	15	ACT	常规护理	4周,2次/周,90 min/次,面对面	①②	BAI、BHI
周小帅^[19]	2020	乳腺癌	30	30	ACT	常规护理	2周,1次/2d,30 min/次,面对面	①②	SAS、SDS
姚晚侠等^[20]	2020	乳腺癌	140	140	ACT	常规护理	3月,1次/月,面对面+电话+微信	①②	SAS、SDS
潘虹等^[21]	2020	胰腺癌	37	42	ACT	常规护理	8周,6次/周,90 min/次,面对面	①②③	DASS、AAQ-Ⅱ
王婷婷等^[22]	2022	食管癌	50	50	ACT	常规护理	4周,面对面	①②③④	SAS、SDS、AAQ-Ⅱ、QLQ-C30
胡迎冬等^[23]	2016	乳腺癌	41	39	ACT	常规护理	2周,1次/2d,30~40 min/次,面对面	①②④	SAS、SDS、FACT
许湘华等^[24]	2019	喉癌	24	24	ACT	常规护理	术前1 d-术后5 d,面对面	③④	AAQ-Ⅱ、FACT
魏慧等^[25]	2020	直肠癌	59	59	ACT	常规护理	术前1 d-术后5 d,面对面	①②	HADS、AAQ-Ⅱ

纳入文献	年份 (年)	癌症类型	样本量(例)		干预措施		干预时间及方式	结局指标	测量工具
纳入文献	年份 (年)	癌症类型	观察组	对照组	观察组	对照组	干预时间及方式	结局指标	测量工具
Shari等^[11]	2020	乳腺癌	30	30	ACT	常规护理	12周,1次/3周,1 h/次,面对面	①②③	HADS、AAQ-Ⅱ
Serfaty等^[12]	2018	各种类型	20	22	ACT+TC	TC	3月,8次/周,1 h/次,面对面	③④	HADS、FACT
Fernández-Rodríguez等^[14]	2020	各种类型	12	17	ACT	常规护理	3月,12次/周,90 min/次,面对面	①②③	HADS、AAQ-Ⅱ
González-Fernández等^[15]	2018	乳腺癌	12	23	ACT	常规护理	12次/周,90 min/次,面对面	①②③	HADS、AAQ-Ⅱ
Johns等^[16]	2019	乳腺癌	31	31	ACT	SE	6周, 1次/7d, 2 h/次,面对面	①②	GAD、PHQ
Li等^[17]	2022	肺癌	20	20	ACT	常规护理	1次/周,60~90 min/次,面对面+网络视频	①②④	GAD、PHQ
Mohabbat-Bahar等^[18]	2015	乳腺癌	15	15	ACT	常规护理	4周,2次/周,90 min/次,面对面	①②	BAI、BHI
周小帅^[19]	2020	乳腺癌	30	30	ACT	常规护理	2周,1次/2d,30 min/次,面对面	①②	SAS、SDS
姚晚侠等^[20]	2020	乳腺癌	140	140	ACT	常规护理	3月,1次/月,面对面+电话+微信	①②	SAS、SDS
潘虹等^[21]	2020	胰腺癌	37	42	ACT	常规护理	8周,6次/周,90 min/次,面对面	①②③	DASS、AAQ-Ⅱ
王婷婷等^[22]	2022	食管癌	50	50	ACT	常规护理	4周,面对面	①②③④	SAS、SDS、AAQ-Ⅱ、QLQ-C30
胡迎冬等^[23]	2016	乳腺癌	41	39	ACT	常规护理	2周,1次/2d,30~40 min/次,面对面	①②④	SAS、SDS、FACT
许湘华等^[24]	2019	喉癌	24	24	ACT	常规护理	术前1 d-术后5 d,面对面	③④	AAQ-Ⅱ、FACT
魏慧等^[25]	2020	直肠癌	59	59	ACT	常规护理	术前1 d-术后5 d,面对面	①②	HADS、AAQ-Ⅱ

结局指标	纳入研究	异质性		效应模型	Meta分析结果
结局指标	纳入研究	P值	I²(%)	效应模型	SMD/MD	95%CI	Z值	P值
焦虑评分	11	0.36	9	固定	-0.99^*	[-1.14,-0.85]	13.62	<0.01
抑郁评分	10	0.29	16	固定	-0.68^*	[-0.83,-0.54]	9.42	<0.01
心理灵活性	6	0.95	0	固定	-2.17^#	[-2.77,-1.57]	7.11	<0.01
生活质量	4	0.10	49	固定	0.70^*	[0.43,0.97]	5.10	<0.01

结局指标	纳入研究	异质性		效应模型	Meta分析结果
结局指标	纳入研究	P值	I²(%)	效应模型	SMD/MD	95%CI	Z值	P值
焦虑评分	11	0.36	9	固定	-0.99^*	[-1.14,-0.85]	13.62	<0.01
抑郁评分	10	0.29	16	固定	-0.68^*	[-0.83,-0.54]	9.42	<0.01
心理灵活性	6	0.95	0	固定	-2.17^#	[-2.77,-1.57]	7.11	<0.01
生活质量	4	0.10	49	固定	0.70^*	[0.43,0.97]	5.10	<0.01