我国癌症病情告知对癌症患者及家属焦虑抑郁和生活质量影响Meta分析

Meta-analysis of the impact of cancer condition notification on anxiety,depression and quality of life of cancer patients and their families in China

目的采用Meta分析方法探讨癌症病情告知对患者及家属焦虑、抑郁和生活质量的影响。方法检索PubMed、Cochrane Library,中国知识基础设施工程(CNKI)、万方和维普电子数据库,查找自建库至2020-08-31公开发表的关于我国癌症病情告知对癌症患者及家属焦虑抑郁和生活质量影响的相关文献。中文检索式:(肿瘤OR癌症)AND(病情告知OR知情同意)AND(焦虑OR抑郁);英文检索式:(cancer OR tumor OR neoplasm)AND("disease informing"OR"truth disclosure"OR informed consent"OR notification)AND(anxiety OR depression)AND(China OR Chinese)。由2位研究者独立提取资料,采用R3.12进行Meta分析。结果共纳入13篇文献,其中癌症病情告知组832例,不告知组824例。Meta分析结果显示,患者焦虑评分(SMD=-0.43,95%CI:-0.92〜0.05,Z=1.76,P=0.08)、抑郁患病率(OR=0.68,95%CI:0.43〜1.06,Z=1.70,P=0.09)和生活质量测定量表评分(SMD=-0.04,95%CI:-0.19~0.12,Z=0.47,P=0.64)在癌症病情不告知组的得分以及患病率更低,2组差异均无统计学意义;患者抑郁评分(SMD=-0.51,95%CI:-0.930.08,Z=2.35,P=0.02)、家属焦虑评分(SMD=-1.00,95%CI:-1.410.59,Z=4.79,P<0.01)、家属抑郁评分(SMD=-1.76,95%CI:-3.270.24,Z=2.28,P=0.03)和患者焦虑患病率(OR=0.57,95%CI:0.38~0.86,Z=2.67,P=0.01)在病情告知组的得分和患病率更低,2组差异有统计学意义。结论告知癌症病情更有利于缓解癌症患者及家属的焦虑和抑郁,可以改善患者的生活质量,但受所纳入文献的数量及质量的影响,可能会造成一定的偏倚,仍然需要高质量和大样本的研究去证实。

Objective To investigate the impact on the psychological status(e.g. anxiety,depression) and quality of life of patients and their families as well after the disclosure of cancer disease. Methods Relevant literature was collected from electronic databases of PubMed,Cochrane Library,CNKI,Wanfang and Weipu from the day they were created till August 31,2020,to access the information on the impact of cancer notification on the psychological status(e.g. anxiety and depression) of patients and families as well as their quality of life. When searched the Chinese and Einglish database,(cancer OR tumor OR neoplasm) AND( "disease informing" OR "truth disclosure" OR "informed consent" OR notification) AND(anxiety OR depression) AND(China OR Chinese) was a retrieval type. Two researchers independently extracted data and used R 3.12 software for Meta analysis.Results A total of 13 articles were included,including 832 cases in the cancer notification group and 824 cases in the non-information group.Meta-analysis results showed that with respect to patient anxiety score(SMD=-0.43,95%CI:-0.92-0.05,Z=1.76,P=0.08),prevalence of depression(OR=0.68,95%CI:0.43-1.06,Z=1.70,P=0.09)and QLQ score(SMD=-0.04,95%CI:-0.19-0.12,Z=0.47,P=0.64),the score and prevalence of cancer in the uninformed group were lower,and the difference between the two groups was not statistically significant.In terms of patient depression score(SMD=-0.51,95%CI:-0.93--0.08,Z=2.35,P=0.02),family anxiety score(SMD=-1.00,95%CI:-1.41--0.59,Z=4.79,P<0.01),family depression score(SMD=-1.76,95%CI:-3.27--0.24,Z=2.28,P=0.03)and the prevalence of anxiety(OR=0.57,95%CI:0.38-0.86,Z=2.67,P=0.01),the score and prevalence of the disease in notification group were lower,and the difference between the two groups was statistically significant.Conclusions In China,informing cancer patients is more conducive to alleviating the anxiety and depression of cancer patients and their families,and can improve the quality of life of patients.However,due to the quantity and quality of the included literature,high-quality and large-sample studies are still needed to confirm.