Specialist nursing interventions for inflammatory bowel disease
Published Online: 7 OCT 2009
Assessed as up-to-date: 29 SEP 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Belling R, McLaren S, Woods L. Specialist nursing interventions for inflammatory bowel disease. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006597. DOI: 10.1002/14651858.CD006597.pub2.
- Publication Status: New
- Published Online: 7 OCT 2009
The number, type and roles of specialist nurses dedicated to the care and management of patients with inflammatory bowel disease is increasing. Despite this increase, there has been little evidence to date to demonstrate the effectiveness of specialist nursing interventions. This review aims to identify and evaluate the impact of specialist nursing interventions on management of inflammatory bowel disease, access to treatment, remission, morbidity and quality of life.
To identify and evaluate the impact of specialist nursing interventions for improving the care and management of patients with inflammatory bowel disease (IBD).
A comprehensive search of databases including the Cochrane Library, MEDLINE, and British Nursing Index was carried out to identify trials. References from relevant papers were searched and hand searching was undertaken of relevant publications including gastroenterology conference proceedings to identify additional trials (date of last search 30 September 2008).
Randomised controlled trials, controlled before and after studies and interrupted time series studies of gastroenterology and IBD specialist nurses intending to improve access and outcomes for patients with ulcerative colitis and Crohn's disease were considered for inclusion.
Data collection and analysis
Two investigators independently extracted data and assessed trial quality. Any discrepancies were resolved by consensus.
One randomised controlled trial of 100 IBD patients receiving a specialist nurse delivered counselling package (n = 50) or routine outpatient clinic follow-up (n = 50), with assessments at entry and six and 12 months, was included in this review. This study was of low methodological quality. Disease remission, patient compliance, clinical improvement, utilisation of nurse-led services, patient satisfaction, hospital admission, outpatient attendance, progression to surgery, length of hospital stay and cost effectiveness data were not reported. Pooled mean mental health scores at 6 months were higher in patients who received nurse-led counselling compared to patients who received routine follow-up. However, this difference was not statistically significant (WMD 3.67; 95% CI -0.44 to 7.77; P = 0.08). Other pooled assessments of physical and psychological well-being showed no statistically significant differences.
Although specialist nurse counselling interventions might provide benefit for IBD patients the one included study was of low quality and the results of this study should be interpreted with caution. Higher quality trials of gastroenterology and IBD specialist nursing interventions are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.
Plain language summary
Specialist nurse counselling interventions for patients with inflammatory bowel disease
The number and type of gastroenterology and inflammatory bowel disease specialist nurses is increasing, along with the variety of roles performed in patient care and management. This review included one low quality trial of a specialist nurse counselling intervention compared with routine outpatient clinic follow up. No data were reported on remission outcomes. Counselling by a specialist nurse might improve mental health related quality of life for some IBD patients in the short term. However, the poor quality of the one included study does not allow for any definitive conclusions regarding the impact of the nurse-led counselling program. Better designed studies are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.
針對資料庫全面搜尋，包括Cochrane Library、MEDLINE和British Nursing Index等，以找出相關試驗。搜尋出相關研究的參考資料，並翻閱相關出版品，包括腸胃病學會議的會議記錄，以找出更多的試驗(最後搜尋日期為2008年9月30日)。
一項有100位炎症性腸病患者接受一位專科護士於研究開始、6個月和12個月時到府諮商服務(n = 50)或固定門診追蹤及評估(n = 50)的隨機對照試驗，納入此回顧研究。此項研究的研究方法品質較差。關於疾病的緩解、患者的遵囑性、臨床症狀的改善、護士到府服務的利用、患者的滿意度、住院人數、門診病人的到診率、手術進展、住院期及成本效率等數據資料皆無報導。在6個月後，接受護士到府服務的患者，其心理健康的平均分數比接受固定追蹤患者的分數高。不過差異並無統計上的意義(WMD 3.67; 95% CI 0.44 −.77; P = 0.08)。而身體上和心理學上的評估也無統計上的明顯差異。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。