摘要
目的评价健康行动过程取向(health action process approach,HAPA)理论联合正念减压干预康复手段对直肠癌放化疗患者的康复效果,为临床康复方案提供循证依据。方法检索中国知网(China national knowledge infrastructure,CNKI)、维普中文科技期刊数据库、WanFang、中国生物医学文献数据库(Chinese biomedical literature database,CBM)、PubMed、Embase、Cochrane Library共7个大数据库及中国临床试验注册中心、美国临床试验注册中心,纳入采用HAPA理论联合正念减压干预治疗直肠癌放化疗患者的随机对照试验,检索时限为建库至2024年7月,对符合纳入标准的文献进行Meta分析。结果本研究共纳入28篇文献,其中相比于西药常规护理,采用HAPA理论联合正念减压干预对Meta分析结果的贡献最大,贡献度为25.0%。在临床总有效率方面的Meta分析结果比较,HAPA理论联合正念减压干预优于单纯HAPA理论干预(95%CI为1.45~2.49)、单纯正念减压(95%CI为1.65~2.99)及西药常规护理(95%CI为3.65~6.36)。针对连续性结局指标,以标准化均数差(standardized mean difference,SMD)为效应量分析:相比于西药常规护理,HAPA理论联合正念减压干预在生活质量、癌因性疲劳、焦虑抑郁以及睡眠障碍改善率的连续性指标中的效应量最优(SMD=-1.82、-1.65、-1.73、-1.69、-1.58,均P<0.05)。不同干预措施的临床总有效率的累积排序曲线下面积(surface under the cumulative ranking curve,SUCRA)排序为:HAPA理论联合正念减压干预(91.30%)>单纯HAPA理论干预(65.70%)>单纯正念减压(52.40%)>西药常规护理(30.60%)。结论HAPA理论联合正念减压的干预方案对直肠癌放化疗患者的康复效果均优于单一干预措施及西药常规护理,可作为临床优选康复方案。
Objective To evaluate the rehabilitation effects of health action process approach(HAPA)theory combined with mindfulness stress reduction intervention on rectal cancer patients undergoing radiotherapy and chemotherapy,and to provide evidence-based support for clinical rehabilitation programs.Methods A total of 7 major databases were searched,including China national knowledge infrastructure(CNKI),VIP Chinese science and technology journal database,WanFang,China biomedical literature database(CBM),PubMed,Embase and Cochrane Library,as well as the China clinical trial registry and the US clinical trial registry.Randomized controlled trials involving the intervention of HAPA theory combined with mindfulness stress reduction in the treatment of rectal cancer patients undergoing radiotherapy and chemotherapy were included.The search period was from the establishment of the database to July 2024.Metaanalysis was conducted on the literature that met the inclusion criteria.Results A total of 28 articles were included in this study.Compared with the conventional western medicine nursing care,the combination of HAPA theory and mindfulness stress reduction intervention contributed the most to the meta-analysis results,with a contribution rate of 25.0%.The results of the meta-analysis on the overall clinical effectiveness rate are compared,the combination of HAPA theory and mindfulness stress reduction intervention was superior to the simple intervention of HAPA theory(95%CI 1.45-2.49),the simple mindfulness stress reduction intervention(95%CI 1.65-2.99),and the conventional western medicine nursing care(95%CI 3.65-6.36).For continuous outcome measures,the standardized mean difference(SMD)was used as the effect size for analysis:Compared with conventional Western medicine nursing care,the combination of HAPA theory and mindfulness stress reduction intervention had the best effect size in the continuous indicators of quality of life,cancer-related fatigue,anxiety and depression,improvement rate of sleep disorders(SMD=-1.82,-1.65,-1.73,-1.69,-1.58,all P<0.05).Compared with the overall clinical effectiveness rates of different intervention measures,the ranking based on the surface under the cumulative ranking curve(SUCRA)is as follows:the combined of HAPA theory and mindfulness stress reduction intervention(91.30%)>the simple intervention of HAPA theory(65.70%)>the simple mindfulness stress reduction intervention(52.40%)>conventional western medicine nursing care(30.60%).Conclusion The rehabilitation effect of the combination of HAPA theory and mindfulness stress reduction intervention on patients with rectal cancer undergoing radiotherapy and chemotherapy is better than single intervention measures and conventional western medicine nursing care,which can be used as a clinical optimal rehabilitation program.
作者
朱金玉
牙玉洁
吴玉宏
覃方愿
ZHU Jinyu;YA Yujie;WU Yuhong;QIN Fangyuan(Department of Oncology,the People's Hospital of Hechi,Hechi Guangxi 547000,China)
出处
《中国卫生标准管理》
2026年第2期92-96,共5页
China Health Standard Management
关键词
直肠癌
健康行动过程取向理论
正念减压
干预方案
西药常规护理
META分析
rectal cancer
health action process approach theory
mindfulness stress reduction
intervention program
conventional western medicine nursing care
meta-analysis
