Interventions for improving communication with children and adolescents about their cancer

 

Abstract

Background

Communication with children and adolescents with cancer about their disease and treatment and the implications of these is an important aspect of good quality care. It is often poorly performed in practice. Various interventions have been developed that aim to enhance communication involving children or adolescents with cancer.

Objectives

To assess the effects of interventions for improving communication with children and/or adolescents about their cancer, its treatment and their implications, updating the 2003 version of this review.

Search methods

In April 2006 we updated searches of the following sources: CENTRAL (The Cochrane Library, issue 1 2006); MEDLINE (Ovid), (2003 to March week 5 2006); EMBASE (Ovid) (2003 to 2006 week 13); PsycINFO (Ovid) (2003 to March week 5 2006); CINAHL (Ovid) (2003 to March week 5 2006); ERIC (CSA) (earliest to 2006); Sociological Abstracts (CSA) (earliest to 2006); Dissertation Abstracts: (2002 to 6 April 2006).

In 2003 we conducted searches of CENTRAL; MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, Sociological Abstracts and Dissertation Abstracts.

For the initial (2001) publication of this review we also searched the following databases: PsycLIT; Cancerlit; Sociofile; Health Management Information Consortium; ASSIA; LISA; PAIS; Information Science Abstracts; JICST; Pascal; Linguistics and Language Behavior Abstracts; Mental Health Abstracts; AMED; MANTIS.

We also searched the bibliographies of studies assessed for inclusion, and contacted experts in the field.

Selection criteria

Randomised and non-randomised controlled trials, and before and after studies, evaluating the effects of interventions for improving communication with children and/or adolescents about their cancer, treatment and related issues.

Data collection and analysis

Data relating to the interventions, populations and outcomes studied and the design and methodological quality of included studies were extracted by one review author and checked by another review author. We present a narrative summary of the results.

Main results

One new study met the criteria for inclusion; in total we have included ten studies involving 438 participants. Studies were diverse in terms of the interventions evaluated, study designs used, types of people who participated and the outcomes measured.

One study of a computer-assisted education programme reported improvements in knowledge and understanding about blood counts and cancer symptoms. One study of a CD-ROM about leukaemia reported an improvement in children's feelings of control over their health. One study of art therapy as support for children during painful procedures reported an increase in positive, collaborative behaviour. Two out of two studies of school reintegration programs reported improvements in some aspects of psychosocial wellbeing (one in anxiety and one in depression), social wellbeing (two in social competence and one in social support) and behavioural problems; and one reported improvements in physical competence. One newly-identified study of a multifaceted interactive intervention reported a reduction in distress (as measured by heart rate) related to radiation therapy.

Two studies of group therapy, one of planned play and story telling, and one of a self-care coping intervention, found no significant effects on the psychological or clinical outcomes measured.

Authors' conclusions

Interventions to enhance communication involving children and adolescents with cancer have not been widely or rigorously assessed. The weak evidence that exists suggests that some children and adolescents with cancer may derive some benefit from specific information-giving programs, from support before and during particular procedures, and from interventions that aim to facilitate their reintegration into school and social activities. More research is needed to investigate the effects of these and other related interventions.

 

Plain language summary

Ways of improving communication with children and adolescents about their cancer

Communicating about cancer may help some children and adolescents understand the disease and its treatment and help them cope better with their cancer.

Children and adolescents with cancer face many issues and may benefit from greater opportunities to talk to health professionals. Concerns about their illness and its treatment can result in psychological, behavioural and developmental problems. Various methods of communication have been designed to provide better access to the knowledge and understanding these children and adolescents require. The review of trials found that specific information-giving programs, support before and during particular procedures, and school reintegration programs may benefit children and adolescents with cancer when individual factors such as their age, level of understanding and medical condition have been considered. More research is needed.

 

摘要

背景

改善與小孩及青少年關於其癌症溝通之介入

與具有癌症之小孩及青少年作關於其疾病、治療、及影響的溝通，對於良好的照顧品質來說是重要的，但其在臨床上卻常被不良的執行。各種不同的介入已被發展用以增進具有癌症小孩及青少年的溝通。

目標

評估改善與小孩及/或青少年溝通關於其癌症、治療及影響的介入成效，並更新2003年度關於此文獻回顧的版本。

搜尋策略

於2006年4月，我們更新了下列來源的搜尋：CENTRAL (The Cochrane Library, issue 1 2006); MEDLINE (Ovid), (2003 to March week 5 2006); EMBASE (Ovid) (2003 to 2006 week 13); PsycINFO (Ovid) (2003 to March week 5 2006); CINAHL (Ovid) (2003 to March week 5 2006); ERIC (CSA) (earliest to 2006); Sociological Abstracts (CSA) (earliest to 2006); Dissertation Abstracts: (2002 to 6 April 2006)。在2003年，我們執行了CENTRAL; MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, Sociological Abstracts and Dissertation Abstracts的搜尋。在2001年此一文獻回顧的原版本，我們亦搜尋了下列的資料庫：PsycLIT; Cancerlit; Sociofile; Health Management Information Consortium; ASSIA; LISA; PAIS; Information Science Abstracts; JICST; Pascal; Linguistics and Language Behavior Abstracts; Mental Health Abstracts; AMED; MANTIS。我們也搜尋了經評估後納入的研究參考書目，並與此領域的專家聯絡。

選擇標準

評估改善與小孩及/或青少年溝通關於其癌症、治療及其相關議題之介入成效的隨機與非隨機對照試驗、及前後對照研究(before and after studies)。

資料收集與分析

關於介入、族群及研究結果的相關資料、納入之研究的設計、及方法品質先由一評論作者作節錄，再由另一評論作者作審查。我們以記敘文總結的方式呈現結果。

主要結論

本次有一個符合納入條件的新研究，我們總共納入10個研究，包含438位參與者。這些研究在評估的介入、研究設計的使用、參與者的類別、及測量的結果皆不盡相同。一個以電腦輔助的教育計劃研究發現，在關於血液計數及癌症症狀的知識及了解方面有所改善。一個關於白血病之唯讀記憶光碟(CDROM)的研究發現可以改善小孩對於其對健康的控制感覺。一個研究顯示以藝術治療作為小孩於會產生疼痛之處置過程的支持，可以增加正向、合作的行為。兩個學校之再整合計劃研究報告發現可以改善在某些精神社會之安適(一為焦慮、另一為憂鬱)、社會安適(兩個為社交能力，一個為社會支持)、及行為問題；而另一個研究發現在生理能力上有所改善。一個以多面向互動介入的新研究，發現可減少有關放射治療的苦惱(經由心跳速率評估)。兩個團體治療的研究顯示，一個以有計畫性的遊戲及說故事，而另一個以自我照顧處置介入研究，發現在精神及臨床結果評估上並無明顯影響。

作者結論

增進具有癌症小孩及青少年之溝通的介入，並沒有被廣泛或嚴謹的評估。僅有薄弱的證據顯示，某些有癌症的小孩及青少年可能從特定資訊給予的計畫中得到好處，這些計畫係在特定處置程序之前及處置過程期間給予支持，也包含一些促進小孩及青少年再整合於學校及社會之活動的介入。關於這些及其他相關介入之成效，仍需要更多的研究。

翻譯人

本摘要由成功大學附設醫院賴麗容翻譯。

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

總結

關於癌症的溝通可幫助某些小孩及青少年了解疾病及其治療，並且幫助他們更能面對癌症。具有癌症的小孩及青少年面對很多議題，也可能會有較多的機會與健康專業人員對談，從而獲益。對於她們疾病的及治療的擔心會造成精神、行為及發展的問題。很多溝通的方法已被設計用來提供這些小孩及青少年有更好的管道以獲得所需要的知識及了解。本篇研究回顧發現，當考慮個別因素，例如其年齡、了解程度、及醫療病況，特定的資訊提供計畫、特定的處置過程前及處置期間的支持、及學校的再整合計畫，可能使有癌症的小孩及青少年受益。然而此方面仍然需要更多的研究。