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

患者個人用藥的書面資訊

藥物是大多數醫療服務中最常使用到的處置。跟所有的治療一樣，服藥的患者需要充足的資訊，來幫助他們能有效地服藥、了解到藥物潛在的危害和幫助，讓他們得以作出服藥有關的知情決策。書面的藥品資訊，例如單張或透過網路，也許是達成上述目標的一種方法。

目標

評估提供患者個人服用藥物的書面資料，對於知識、態度、行為以及預後等所造成的影響 (此處所指的藥物包括處方藥與成藥) 。

搜尋策略

截至2007年3月，我們搜尋了MEDLINE、 EMBASE、CINAHL、The Cochrane Library、PsycINFO以及其他資料庫。我們人工搜尋5個期刊的目錄，以及所收納的研究的參考文獻清單；並且也與本領域的專家連絡。

選擇標準

收錄：1.比較有或沒有書面藥物資訊 2.或比較兩種以上書面藥物資訊呈現方式的隨機對照試驗(Randomised controlled trials ；RCTs) 。我們只納入以知識、態度和行為做為結果測量指標的試驗。文獻搜尋上沒有語言限制。

資料收集與分析

由兩位作者獨立摘錄有關介入、試驗方法以及結果測量等資訊，萬一兩者有出入時，則以討論的方式來取得共識。這些研究在介入和結果測量上呈現異質性，代表資料整合並不可行，因此我們改採文字描述和表格來呈現分析結果。

主要結論

我們納入了25個RCTs，總參與人數為4788人。在12個試驗中，有6個顯示相較於沒有提供書面藥物資訊，提供書面藥物資訊可以顯著增加患者對藥物的知識。我們沒辦法合併這些試驗的結果，這意味著我們無法證實書面資訊是否有效增加患者藥物的知識。關於態度和行為層次的影響則是呈現不一的結果，無法證實書面資訊和患者使用藥物的態度和行為有關。沒有研究顯示書面藥物資訊會造成任何負面影響。

作者結論

各研究合併而成的證據強度不足，因而無法斷言書面藥物資訊對服藥相關的知識、態度、行為之改變是有幫助的。有部份證據顯示出書面資訊可以增加知識，然而這些試驗品質普遍不佳，因此減低了其研究結果的可信度。如果要探討書面資訊的影響，必須有更完善的研究設計，並且採用具一致性且可驗證的結果測量指標，亦須評估以網路為基礎的藥品資訊。更重要的是，書面藥物資訊的設計和內容上必須以臨床上容易使用為基礎，方可有效提升其效果，以協助患者正確地服藥。

翻譯人

本摘要由成功大學附設醫院邱曉萱翻譯。

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

總結

藥物是大多數醫療服務中最常使用的處置，患者在服藥的時候需要品質良好的資訊，才能幫助他們能有效地服藥、了解到藥物潛在的危害和幫助，讓他們得以作出服藥有關的知情決策。有些國家會連同藥物一併提供資訊單張，且這些資訊也可透過網路取得。本回顧檢驗個人的書面用藥資訊，是否可以改善相關知識、態度或是相關用藥行為。基於以下原故，我們發現難以作出結論：首先，因為我們所納入的研究，其結果測量的項目和方法上不盡相同，使得我們無法整合他們的研究結果。其次，這些試驗提供給患者的書面資訊所呈現方式也有差異，且大多數試驗所設計出的單張並未把握易讀的原則。第三，不少試驗的報告內容不清楚，導致我們無法得知這些試驗執行上的正確性。即使存在這些限制，還是有部份試驗採用了不同的資訊類型和測量方式，顯示書面資訊可以增進患者用藥知識。書面藥物資訊對那些希望透過單張多了解所用藥物的患者算是一種激勵。沒有研究顯示書面資訊是有害的，未來的研究應該採用更完善的方式，並且在不同情境下測量同一種指標。透過書寫及設計良好用藥資訊，促進改善用藥知識是一件相當重要的事。患者逐漸懂得從網路尋求健康資訊，包括藥物資訊，然而我們發現沒有試驗討論過以網路為基礎的用藥資訊是否會改變患者的知識態度與行為。