癌症患者化疗所致周围神经病变体验质性研究的系统评价

Systematic evaluation of experiential qualitative study on chemotherapy-induced peripheral neuropathy in cancer patients

目的整合相关质性研究,系统评价癌症患者化疗所致周围神经病变(CIPN)的体验。方法检索PubMed、Embase、Web of Science、Science Direct、PsycINFO和中文数据库CNKI、万方、维普、中国生物医学文献数据库从建库至2018年7月31日相关的质性研究。采用澳大利亚循证卫生保健中心(JBI)质性研究质量评价标准对文献进行评价,并采用汇集性整合方法对结果进行整合。结果共纳入6项研究,提炼19项结果,归为8个类别,合成4个整合结果。整合结果1:周围神经病变是一种不明确的症状体验,复杂多样,主要表现为周围神经病变症状模糊,患者缺乏信息支持和低报告率。整合结果2:周围神经病变常被患者误认为是一种不太重要的风险,主要表现为患者对CIPN较低的风险感知,医务人员对CIPN的重视不足,导致CIPN的低评估率。整合结果3:CIPN严重影响患者的生活质量,主要表现为对患者日常生活的影响和情绪困扰等层面。整合结果4:CIPN为癌症幸存者的一种特征,患者对于药物治疗效果的不确定性、减轻或控制症状后逐渐适应症状的存在。结论CIPN症状复杂多样,需要提高医务人员的评估能力和患者的自我管理水平,进而减轻CIPN症状,提高患者整体生存质量。

Objective To integrate relevant qualitative studies and to evaluate the experience of chemotherapy-induced peripheral neuropathy (CIPN) systematically in cancer patients. Methods Relevant qualitative studies were retrieved from PubMed, Embase, Web of Science, Science Direct, PsycINFO and Chinese databases such as CNKI, Wanfang, VIP and SinoMed from when they were founded to July 31, 2018. The Joanna Briggs Institute (JBI) 's qualitative study quality evaluation standards was used to evaluate the literature, and the converging integration method was used to integrate the results. Results Totally 6 studies were included, and they boiled down to 19 results, 8 types and 4 integration results. Integration result 1: CIPN was an indefinite symptom experience, which was complex and mainly reflected by unclear CIPN symptoms, lack of information support for patients and low reporting rates. Integration result 2: CIPN was misunderstood by patients as an unimportant risk which was mainly reflected as patients' low risk awareness of CIPN, lack of attention to CIPN from medical workers and thus low evaluation rates of CIPN. Integration result 3: CIPN affected patients' quality of life severely, as reflected by its effects on patients' daily life and emotional disturbance. Integration result 4: CIPN was a characteristic of cancer survivors as reflected by uncertainty of drug treatment in patients and their adaptation to the symptoms when the symptoms were mitigated or controlled. Conclusions The symptoms of CIPN is complex. Medical workers' evaluation capacity and patients' self-management shall be enhanced so as to mitigate CIPN symptoms and improve the overall quality of life of patients.