Information provision for stroke patients and their caregivers

 

Abstract

Background

Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues.

Objectives

To assess the effectiveness of information provision strategies in improving the outcome for stroke patients and/or their identified caregivers.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched May 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2007), MEDLINE (1966 to March 2007), EMBASE (1980 to March 2007), CINAHL (1982 to March 2007), PsycINFO (1974 to March 2007), Science Citation Index and Social Science Citation Index (1981 to March 2007), Assia (1987 to March 2007), Index to UK theses (1970 to March 2007), Dissertation Abstracts (1961 to March 2007), ongoing trials and research registers, bibliographies of retrieved papers, relevant articles and books, and the Journal of Advanced Nursing. We also contacted researchers for additional information.

Selection criteria

Randomised trials involving patients or carers of patients with a clinical diagnosis of stroke or transient ischaemic attack (TIA) where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone.

Data collection and analysis

Two review authors independently assessed trial eligibility and methodological quality and extracted data. Primary outcomes were knowledge about stroke and stroke services, and impact on mood.

Main results

Seventeen trials involving 1773 patient and 1058 carer participants were included. Eight evaluated a passive and nine an active information intervention. Meta-analyses showed a significant effect in favour of the intervention on patient and carer knowledge, one aspect of patient satisfaction, and patient depression scores. There was no significant effect on number of cases of anxiety or depression in patients, carer mood or satisfaction, or death. Qualitative analyses found no strong evidence of an effect on other outcomes. Post-hoc subgroup analyses showed that active information had a significantly greater effect than passive information on patient mood but not on other outcomes.

Authors' conclusions

There is evidence that information improves patient and carer knowledge of stroke, aspects of patient satisfaction, and reduces patient depression scores. However, the reduction in depression scores was small and probably clinically insignificant. Although the best way to provide information is still unclear there is some evidence that strategies that actively involve patients and carers and include planned follow up for clarification and reinforcement have a greater effect on patient mood.

 

Plain language summary

Information provision for stroke patients and their caregivers

Studies have shown that stroke survivors and their carers often feel they have not been given enough information about stroke and feel unprepared for life after discharge from hospital. However, the best way to provide information after stroke is unclear. The authors of this review looked at the evidence for the effectiveness of providing information to patients, or carers of patients, who have had a stroke or transient ischaemic attack (TIA), sometimes called a mini-stroke. They examined randomised trials (studies) in which one group of stroke patients or carers who were given the intervention being tested (such as a course of lectures) was compared with a group of stroke patients or carers who received standard care. Seventeen studies, involving 1773 patients and 1058 carers, were included in the review. Overall, the studies showed that providing information to patients and carers improved their knowledge of stroke and increased patient satisfaction with some, but not all, of the information they received about stroke. There was also an effect on reducing patient depression, although the reduction was small and would probably not be enough to seem meaningful to patients. When information was provided in a way that more actively involved patients and carers, for example by offering repeated opportunities to ask questions, it had more effect on patient mood than information which was given on one occasion only. There is not much evidence that providing information had effects on other aspects of patient or carer stroke recovery such as independence or social activities.

 

摘要

背景

中風病人及其照護者的資訊提供

資訊提供已被建議為中風後提供之服務的重要構成要素。但是，研究指出病人對中風及其相關問題的了解仍然是欠缺的。我們決定著手做一個對中風病人及其照顧者的資訊提供策略的系統的回顧。

目標

為了評估資訊提供以及(或者是)教育策略對改善中風病人以及(或者是)主要照顧者之臨床結果的成效。

搜尋策略

於Cochrane Stroke Group Specialised Trials Register (2000年6月最後一次搜尋) 中確認的相關試驗。另外以介入治療為基礎之研究策略有包含：The Cochrane Controlled Trials Register (CENTRAL/CCTR)、Medline、Embase、CINAHL、ISI citation index、Science and Social Science Citation Indexes、ISI Web of Science Service、Aslib Index to UK theses、Dissertation Abstracts International、ASSIA以及Psychlit/PsycINFO。我們也搜尋Journal of Advanced Nursing，檢索論文的參考書目，相關的文獻和書籍。

選擇標準

2或3位研究者獨立地評估確認為合格的試驗和摘要、方法學品質和其他參與者的特色。

資料收集與分析

我們以擷取試驗數據之格式獨立地擷取資料。主要的結果是關於中風和中風服務，以及中風對健康(尤其是情緒)之影響的知識。

主要結論

我們發現152篇摘要，其中有36個研究可能與這篇回顧論文有關。目前的分析包括9個已完成的試驗，有8個更進一步的研究仍在進行中。在9個試驗中，有三個試驗評估計畫性演講的成效，而其他的試驗評估資訊的提供。有一些證據顯示，資訊提供結合教育性的講習能增進知識，而且比只提供資訊更為有效。資訊提供只有對情緒、對於病人和照顧者感受到的健康狀態或生活品質沒有效果。2個試驗使用客觀性的滿意度評估，在不同組別之間並沒有發現顯著的不同。1個試驗報告：對照顧者的資訊提供和教育講習能增進居家照護功能。

作者結論

由於試驗的品質不一以及所使用的成果評量方式類別相當廣泛，這篇回顧論文的結果是有限的。資訊提供的一般成效並沒有被確定地證實。未來的工作課題，應該要滿足病人和照顧者表達的需求，並尋求確實能在臨床工作上成功實行之適當教育策略。

翻譯人

本摘要由奇美醫院張偉倫翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以衛教單張、小冊子或資料袋的形式對中風後的病人提供資訊也許並不有效。中風生還者及其照顧者通常感到他們沒有被給予足夠的關於中風的資訊。以小冊子、衛教單張或資料袋的形式提供資訊也許無法改善它們對中風或本身一般福利的了解。教育性的演講也許更為有效，但是試驗結果尚未具有決定性。未來的研究應該要針對能提供可以滿足中風病人及照顧者所確實需要的資訊。