叙事护理对乳腺癌术后患者负性情绪及病耻感干预效果的Meta分析

Meta-analysis of the Intervention Effect of Narrative Nursing on Negative Emotion and Stigma in Patients Undergoing Breast Cancer Surgery

目的评价叙事护理对乳腺癌术后患者负性情绪及病耻感的干预效果。方法系统检索PubMed、Cochrane Library、Embase、中国知网、中国生物医学文献数据库、万方数据库及维普中文科技期刊数据库从建库至2022年3月1日公开发表的关于叙事护理对乳腺癌术后患者负性情绪、病耻感影响的随机对照试验,RevMan 5.4软件进行Meta分析。结果最终纳入14篇文献。结果表明,叙事护理降低乳腺癌术后患者焦虑、抑郁情绪及病耻感总分的效果均优于对照组,且随着干预时间的延长,降低病耻感总分、社会隔离感和内在羞耻感的效果更显著,差异有统计学意义(均P<0.01);经济无保障感只在干预>3个月时略优于对照组[MD=-0.17,95%CI(-0.31,-0.03),P=0.02],社会排斥感在干预3个月[MD=-1.50,95%CI(-1.86,-1.14),P<0.01]及>3个月[MD=-2.36,95%CI(-2.70,-2.02),P<0.01]时优于对照组。结论叙事护理可在一定程度上改善乳腺癌术后患者的焦虑、抑郁情绪,降低病耻感水平,但还需要更多高质量研究进一步验证。

Objective To evaluate the intervention effect of narrative nursing on negative emotion and stigma in patients undergoing breast cancer surgery.Methods Published randomized controlled trials on the effect of narrative nursing on negative emotion and stigma in patients undergoing breast cancer surgery were systematically retrieved in PubMed,Cochrane Library,Embase,CNKI,CBMdisc,Wanfang Data and VIP Chinese Science and Technology Periodicals Database from the establishment of the database to March 01,2022,Then,the included articles were subject to Meta-analysis by using revMan 5.4 software.Results A total of 14 articles were included.The results showed that the effect of narrative nursing on reducing the total scores of anxiety,depression and stigma in patients undergoing breast cancer surgery was better than that in the control group,the effect of reducing the total score of stigma,social alienation and internal shame was more significant as the duration of the intervention increased,with a significant difference(P<0.01 for all);the sense of financial insecurity was only slightly better than that in the control group at>3 months after intervention[MD=-0.17,95%CI(-0.31,-0.03),P=0.02],and social exclusion was better than that in the control group at 3 months[MD=-1.50,95%CI(-1.86,-1.14),P<0.01]and>3 months after intervention[MD=-2.36,95%CI(-2.70,-2.02),P<0.01].Conclusion Narrative nursing can improve the anxiety and depression of patients undergoing breast cancer surgery to some extent,and reduce the level of stigma.However,more highquality studies are needed for further verification.