中国癌症患者家庭照护者照护经历的质性Meta整合

Experiences of Family Caregivers of Chinese Cancer Patients:a Qualitative Meta-synthesis

背景随着中国人口老龄化的加深与癌症发病率的不断攀升,癌症患者的照护需求也随之增加,家庭照护是其中重要的一个方面。照护行为和经历会给家庭照护者带来不同层面的影响,因此系统且全面地对中国癌症患者家庭照护者的照护经历和体验进行研究是极其必要的。目的系统整合与评价中国癌症患者家庭照护者的照护经历与体验。方法2021年1—5月,系统检索Web of Science、PubMed、EmBase、Medline、Cochrane Library、Grew Literature in the Health Sciences、中国知网(CNKI)和万方数据知识服务平台中与中国癌症患者家庭照护者经历有关的质性研究,检索时限为建库至2021-05-23。采用2016版澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心质性研究质量评价标准对文献质量进行评价,纳入符合标准的质性研究,并采用质性Meta整合的方法对所有纳入研究的结果进行综合分析。结果最终纳入符合要求的质性研究19篇(中文6篇和英文13篇),共计295例研究对象(家庭照护者)。其中,9篇文献质量评价结果为A级,偏倚风险很低;10篇评价结果为B级,偏倚风险较低。通过对19篇文献的研究主题进行整合分析,归纳整合为3个一级主题和15个二级主题,3个一级主题分别为以患者为中心的照护需求、照护的负担和照护的正向积极作用。结论通过对中国癌症患者家庭照护者照护经历的质性Meta整合,深入、全面地呈现了中国癌症患者家庭照护者的经历。本研究的结果能够助力完善满足以患者为中心的照护需求的医疗体制建设;在微观、中观和宏观层面加强影响照护经历的积极因素,并且进行死亡和生命教育等干预措施来减轻文化因素对照护经历的负面影响。

Background Care needs of Chinese cancer patients have increased significantly,due to massive population ageing and an increasing cancer incidence rate.Family caregiving,being the most important component in meeting those care needs,comes with many kinds of care burdens for caregivers.Thus,it is vital to systematically examine caregiving experiences of family caregivers for cancer patients.Objective To systematically synthesize the care experiences of family caregivers for Chinese cancer patients.Methods All qualitative studies on the caregiving experiences of family caregivers for Chinese cancer patients were systematically retrieved from Web of Science,PubMed,EmBase,Medline,Cochrane Library,grey literature in the health sciences,CNKI,and Wanfang Data from inception to May 23,2021 between January and May 2021.The 2016 JBI Critical Appraisal Checklist for Qualitative Research was used for quality evaluation.Meta-synthesis of the included studies was performed.Results Nineteen studies(6 in Chinese and 13 in English)were finally included,involving 295 family caregivers in total.Nine were rated A with very low risk of bias,and 10 were rated B with relatively low risk of bias.Three overarching themes containing 15 subthemes emerged:patient-centered care needs,care burden and care gains.Conclusion This qualitative meta-synthesis provides a deep and comprehensive analysis of the care experiences of family caregivers of Chinese cancer patients,which may help improve the construction of medical system to meet the needs of patient-centered care,strengthen the positive factors affecting the care experience at the micro,meso and macro levels,and carry out intervention measures such as death and life education to reduce the negative impact of cultural factors on the care experience.