BACKGROUND: Pediatric, adolescent, and young adult (PAYA) cancer survivors suffer from multiple domains of adverse psychosocial and behavioral outcomes during and after their cancer treatment. This study conducted a systematic review and metaanalysis of psychosocial, behavioral, and supportive interventions for PAYA cancer survivors.
METHODS: We searched 11 electronic databases, 4 professional websites, and manual search of reference lists in existing reviews. We selected randomized controlled trials and controlled trials without randomization focusing on PAYA cancer survivors across six outcome domains.
RESULTS: We included 61 studies (4,402 participants) published between 1987 and 2020. Overall risk of bias across studies was low. We identified an overall moderate and statistically significant treatment effect size for PAYA cancer survivors across six outcome domains.
CONCLUSION: psychosocial, behavioral, and supportive interventions were overall effective for PAYA cancer survivors. However, interventions were not effective for certain outcome domains, and less effective among AYA versus pediatric cancer survivors.
PURPOSE: Music-based interventions can provide non-pharmacological, low-cost treatment for symptoms. This meta-analysis's purpose is to examine music-based interventions' effectiveness on psychological distress symptoms (anxiety, stress, and depressive symptoms), aspects of positive psychology (benefit-finding and resilience), and quality of life (QoL).
METHODS: This meta-analysis was conducted according to PRISMA guidelines and meta-analytic methods suggested by Hedges and Olkin (1985). A systematic literature search between 2000 and 2020 was conducted using CINAHL, MEDLINE, PsycINFO, PubMed, and Web of Science databases. Studies and intervention characteristics were independently coded. The Quality Assessment Tool for Quantitative Studies, Cochrane Collaboration's Tool for Assessing Risk of Bias, Begg and Mazumdar's rank correlation, and Egger's regression test evaluated publication bias.
RESULTS: Twenty-nine of thirty-five eligible studies were included in the statistical analysis. The overall (g = 0.34, SE = 2.27, p < 0.05) and psychological distress symptoms sub-outcome type (g = 0.47, SE = 0.18, p < 0.05) models with moderator analyses were statistically significant.
CONCLUSIONS: Culturally appropriate music-based interventions conducted in the clinical setting that used passive listening with headphones, occurring ≥ 3-times a week over ≥ 2 months, positively impacted gynecology survivors undergoing chemotherapy and surgical treatments. Specifically, interventions that were ≥ 35-minutes, listening to folk or mixed-music positively impacted psychological distress symptoms, whereas new-age music negatively impacted psychological distress symptoms, positive psychology, and QoL outcomes. Future research should examine positive psychology characteristics (perceived levels of positive adjustment, change, and coping) and include larger cohorts with various cancer populations across all cancer survivorship continuum. Culturally appropriate interventions could lead to greater adherence, compliance, and clinical effectiveness and increase the findings' significance and generalizability.
BACKGROUND: Poorly managed preoperative anxiety and pain were reported to slow the postoperative recovery of breast cancer patients. Thus, proactive management using non-pharmacological interventions becomes essential for decreasing opioid or anxiolytics consumption, anxiety level, pain intensity, postoperative complications and improving patients' haemodynamics and satisfaction with care.
PURPOSE: To identify, analyse and synthesise the effects of non-pharmacological interventions on preoperative anxiety and acute postoperative pain in women undergoing breast cancer surgery.
METHOD: For this systematic review, 12 databases including Ovid Nursing, PsycInfo, British Nursing Index, CINAHL, Cochrane Library were searched to identify relevant studies. A total of 6,012 articles were identified from the search, six RCTs and one quasi-experimental study that met the inclusion criteria were included after eligibility screening. Narrative synthesis was used to analyse data extracted from the included articles. The review adhered to the PRISMA guideline.
RESULTS: Twelve outcomes were measured in the included studies, including preoperative anxiety, and acute postoperative pain. Music, massage, aromatherapy and acupuncture were the interventions delivered. Music had a small-to-large effect size and aromatherapy had a small effect size on reducing preoperative anxiety. Also, music had a large effect size whilst acupuncture had a medium effect size on minimising postoperative pain in women undergoing breast cancer surgery.
CONCLUSION: Music, aromatherapy and acupuncture appeared to be effective for reducing preoperative anxiety and postoperative pain in women undergoing breast cancer surgery. However, the small number of studies available for each intervention prevents conclusive statements about which the most effective method.
IMPLICATION FOR CLINICAL PRACTICE: A nursing care pathway that standardises the use of non-pharmacological interventions for the management of both preoperative anxiety and postoperative pain in breast cancer surgery patients should be developed.
BACKGROUND: This is the second update of a Cochrane Review (Issue 4, 2006). Pain and distress from needle-related procedures are common during childhood and can be reduced through use of psychological interventions (cognitive or behavioral strategies, or both). Our first review update (Issue 10, 2013) showed efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents.
OBJECTIVES: To assess the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents.
SEARCH METHODS: We searched six electronic databases for relevant trials: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; PsycINFO; Embase; Web of Science (ISI Web of Knowledge); and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We sent requests for additional studies to pediatric pain and child health electronic listservs. We also searched registries for relevant completed trials: clinicaltrials.gov; and World Health Organization International Clinical Trials Registry Platform (www.who.int.trialsearch). We conducted searches up to September 2017 to identify records published since the last review update in 2013.
SELECTION CRITERIA: We included peer-reviewed published randomized controlled trials (RCTs) with at least five participants per study arm, comparing a psychological intervention with a control or comparison group. Trials involved children aged two to 19 years undergoing any needle-related medical procedure.
DATA COLLECTION AND ANALYSIS: Two review authors extracted data and assessed risks of bias using the Cochrane 'Risk of bias' tool. We examined pain and distress assessed by child self-report, observer global report, and behavioral measurement (primary outcomes). We also examined any reported physiological outcomes and adverse events (secondary outcomes). We used meta-analysis to assess the efficacy of identified psychological interventions relative to a comparator (i.e. no treatment, other active treatment, treatment as usual, or waitlist) for each outcome separately. We used Review Manager 5 software to compute standardized mean differences (SMDs) with 95% confidence intervals (CIs), and GRADE to assess the quality of the evidence.
MAIN RESULTS: We included 59 trials (20 new for this update) with 5550 participants. Needle procedures primarily included venipuncture, intravenous insertion, and vaccine injections. Studies included children aged two to 19 years, with few trials focused on adolescents. The most common psychological interventions were distraction (n = 32), combined cognitive behavioral therapy (CBT; n = 18), and hypnosis (n = 8). Preparation/information (n = 4), breathing (n = 4), suggestion (n = 3), and memory alteration (n = 1) were also included. Control groups were often 'standard care', which varied across studies. Across all studies, 'Risk of bias' scores indicated several domains at high or unclear risk, most notably allocation concealment, blinding of participants and outcome assessment, and selective reporting. We downgraded the quality of evidence largely due to serious study limitations, inconsistency, and imprecision.Very low- to low-quality evidence supported the efficacy of distraction for self-reported pain (n = 30, 2802 participants; SMD -0.56, 95% CI -0.78 to -0.33) and distress (n = 4, 426 participants; SMD -0.82, 95% CI -1.45 to -0.18), observer-reported pain (n = 11, 1512 participants; SMD -0.62, 95% CI -1.00 to -0.23) and distress (n = 5, 1067 participants; SMD -0.72, 95% CI -1.41 to -0.03), and behavioral distress (n = 7, 500 participants; SMD -0.44, 95% CI -0.84 to -0.04). Distraction was not efficacious for behavioral pain (n = 4, 309 participants; SMD -0.33, 95% CI -0.69 to 0.03). Very low-quality evidence indicated hypnosis was efficacious for reducing self-reported pain (n = 5, 176 participants; SMD -1.40, 95% CI -2.32 to -0.48) and distress (n = 5, 176 participants; SMD -2.53, 95% CI -3.93 to -1.12), and behavioral distress (n = 6, 193 participants; SMD -1.15, 95% CI -1.76 to -0.53), but not behavioral pain (n = 2, 69 participants; SMD -0.38, 95% CI -1.57 to 0.81). No studies assessed hypnosis for observer-reported pain and only one study assessed observer-reported distress. Very low- to low-quality evidence supported the efficacy of combined CBT for observer-reported pain (n = 4, 385 participants; SMD -0.52, 95% CI -0.73 to -0.30) and behavioral distress (n = 11, 1105 participants; SMD -0.40, 95% CI -0.67 to -0.14), but not self-reported pain (n = 14, 1359 participants; SMD -0.27, 95% CI -0.58 to 0.03), self-reported distress (n = 6, 234 participants; SMD -0.26, 95% CI -0.56 to 0.04), observer-reported distress (n = 6, 765 participants; SMD 0.08, 95% CI -0.34 to 0.50), or behavioral pain (n = 2, 95 participants; SMD -0.65, 95% CI -2.36 to 1.06). Very low-quality evidence showed efficacy of breathing interventions for self-reported pain (n = 4, 298 participants; SMD -1.04, 95% CI -1.86 to -0.22), but there were too few studies for meta-analysis of other outcomes. Very low-quality evidence revealed no effect for preparation/information (n = 4, 313 participants) or suggestion (n = 3, 218 participants) for any pain or distress outcome. Given only a single trial, we could draw no conclusions about memory alteration. Adverse events of respiratory difficulties were only reported in one breathing intervention.
AUTHORS' CONCLUSIONS: We identified evidence supporting the efficacy of distraction, hypnosis, combined CBT, and breathing interventions for reducing children's needle-related pain or distress, or both. Support for the efficacy of combined CBT and breathing interventions is new from our last review update due to the availability of new evidence. The quality of trials and overall evidence remains low to very low, underscoring the need for improved methodological rigor and trial reporting. Despite low-quality evidence, the potential benefits of reduced pain or distress or both support the evidence in favor of using these interventions in clinical practice.
OBJETIVO: La terapia musical ha experimentado una creciente demanda como terapia complementaria para el tratamiento de síntomas en pacientes de cuidados paliativos. Realizamos una revisión realista de la literatura para desarrollar una mayor comprensión de cómo la musicoterapia puede beneficiar a los pacientes de cuidados paliativos y los mecanismos contextuales que promueven o inhiben su implementación exitosa. MÉTODO: Se realizaron búsquedas en bases de datos electrónicas (CINAHL, Embase, Medline y PsychINFO) para literatura que contenía información sobre musicoterapia para cuidados paliativos. De acuerdo con el enfoque realista, examinamos toda la literatura pertinente para desarrollar teorías que podrían explicar cómo funciona la musicoterapia. RESULTADOS: Se incluyeron 51 artículos en la revisión. Se encontró que la terapia musical tenía un efecto terapéutico sobre el sufrimiento físico, psicológico, emocional y espiritual de los pacientes de cuidados paliativos. También identificamos mecanismos del programa que ayudan a explicar los efectos terapéuticos de la musicoterapia, junto con los contextos facilitadores para su implementación. SIGNIFICADO DE LOS RESULTADOS: La musicoterapia puede ser un enfoque no farmacológico eficaz para el manejo de los síntomas angustiosos en los pacientes de cuidados paliativos. Los hallazgos también sugieren que la musicoterapia en grupo puede ser una manera rentable y eficaz de apoyar al personal que cuida a los pacientes de cuidados paliativos. Animamos a otros a seguir desarrollando la base de evidencia para ampliar nuestra comprensión de cómo funciona la musicoterapia, con el objetivo de informar y mejorar la provisión de musicoterapia para pacientes de cuidados paliativos.
ANTECEDENTES: Los individuos sometidos a procedimientos médicos con frecuencia experimentan dolor y la ansiedad. Intervenciones basadas en música tienen el potencial de ayudar a aliviar estos síntomas.
Objetivo: Esta revisión investigó los efectos de las intervenciones basados en música (musicoterapia y medicina de música) sobre el dolor y la ansiedad en niños y adultos sometidos a procedimientos médicos.
MÉTODOS: Esta revisión sistemática examinó los estudios de intervención aleatorizados controlados música ensayo para controlar el dolor y / o ansiedad informado por el paciente durante los procedimientos médicos. Todos los estudios fueron publicados en revistas revisadas por pares y Inglés. Calidad y riesgo de sesgo se evaluó mediante los criterios de la Lista de verificación para evaluar un informe de un ensayo no farmacológico (CLEAR-TNP).
RESULTADOS: Cincuenta estudios cumplieron los criterios de inclusión, la mayoría de los cuales (84%) tenían un alto riesgo de sesgo. No fue posible realizar un metanálisis porque los estudios variaron mucho en términos de procedimiento médico y el tipo de intervención. Los resultados variaron entre los estudios, con aproximadamente la mitad (48%) lo que indica menos ansiedad para los participantes en la intervención de la música; un menor número de estudios (36%) reportaron menos dolor para los participantes de intervención música.
CONCLUSIONES: Existe la necesidad de definir y diferenciar entre las intervenciones de musicoterapia y medicina de la música en apoyar la investigación procesal claramente. Se necesita más investigación para determinar qué pacientes se beneficiarían más de intervenciones de música durante procedimientos médicos, y qué intervenciones son más beneficiosas. Para mejorar la calidad de la investigación y reducir el riesgo de sesgo, en el diseño de estudios de los investigadores deben considerar cuidadosamente los factores relacionados con el diseño, incluyendo la asignación al azar, la ocultación de la asignación al tratamiento, el cegamiento evaluadores de resultado, y el análisis por intención de tratar. Además, es necesaria la presentación de informes de intervención más detallada al publicar los resultados.
OBJETIVOS: El objetivo del estudio fue evaluar el efecto de la técnica, que incluyen características ambientales, como la música, el diseño del interior, el arte visual y elementos arquitectónicos en los resultados de salud de los pacientes quirúrgicos.
ANTECEDENTES: La curación entornos pueden tener una influencia positiva en muchos pacientes, pero los datos que se centran en el arte en los pacientes quirúrgicos siguen siendo escasos.
MÉTODOS: Se realizó una búsqueda sistemática siguiendo las directrices PRISMA de enero de 2000 a octubre de 2014 sobre el arte en los pacientes quirúrgicos. Para las intervenciones de música, se agruparon los estudios de medición de los resultados de salud (por ejemplo, el dolor, la ansiedad, la presión arterial y frecuencia cardíaca) en un meta-análisis controlada. Para otras formas de arte (ambientales y características de arquitectura y diseño de interiores), hicimos una revisión narrativa, incluyendo también los pacientes no quirúrgicos, y buscamos ejemplos que cubren 3 países.
RESULTADOS: La búsqueda identificó 1101 accesos con 48 estudios que se centran en el arte en el paciente quirúrgico: 47 estudios sobre la intervención musical y 1 de la luz solar. El metaanálisis de estos estudios reveló efectos significativos de la música sobre el dolor después de la cirugía, la ansiedad, la presión arterial sistólica y la frecuencia cardíaca, en comparación con los grupos de control sin música. Efectos de la música eran más grandes con música auto-seleccionados, y menor en las intervenciones quirúrgicas realizadas bajo anestesia general. características de diseño de interiores, como imágenes de la naturaleza y las habitaciones más amplias, y las características arquitectónicas que proporcionan más luz solar tuvieron efectos positivos sobre la ansiedad y el dolor postoperatorio.
Conclusiones: la música seleccionada auto para los pacientes quirúrgicos es una intervención eficaz y de bajo costo para mejorar el bienestar y la recuperación más rápida posible. Aunque potencialmente muy importante, el impacto de las características ambientales y espaciosa arquitectura con un amplio acceso a la luz solar sigue siendo poco explorado en la cirugía. Además es necesaria la investigación experimental para evaluar mejor la magnitud del impacto y la rentabilidad.
Conducting prospective studies in hospices can be difficult. We conducted a systematic review to find randomized trials that have been conducted in US hospices and to review them for quality and potential bias. Ten studies met our inclusion criteria; a wide variety of outcomes were studied. Most of the studies had at least moderate risk of bias due either to incomplete reporting of methods or the inability to blind investigators. To provide better evidence-based hospice care, more well-designed trials that are consistently reported are needed.
ANTECEDENTES: Este es el primer estudio que utiliza meta-análisis como una técnica científica para proporcionar un análisis integrado de la eficacia de la intervención de la música en pacientes con cáncer.
OBJETIVOS: El objetivo de este estudio fue, por el método de meta-análisis, para presentar un resumen de la investigación existente y explorar la eficacia de la intervención de la música en la mejora de la ansiedad, la depresión, el dolor y la fatiga en pacientes con cáncer.
MÉTODOS: El presente estudio recogido diseños de los estudios cuantitativos buscados de la intervención de la música para los pacientes con cáncer publicados 2002-2012. Estos estudios fueron luego con referencias cruzadas utilizando Medical Subject Headings para temas intervención música y los pacientes con cáncer. Indicadores de resultado fueron la ansiedad, la depresión, el dolor y la fatiga. La calidad de los estudios se evaluó utilizando directrices de la Colaboración Cochrane. El tamaño del efecto en los indicadores de resultados utiliza la fórmula ideada por Hedges y Olkin (1985).
Resultados: Los resultados mostraron que las intervenciones de música fueron significativamente eficaz en la mejora de la ansiedad (g = -0,553), la depresión (g = -0,510), dolor (g = -0,656), y la fatiga (g = -0,422) en pacientes con cáncer. Los análisis de subgrupos reveló que la edad y quienes seleccionaron la música fueron los principales factores que influyen en el tamaño del efecto en la reducción de la ansiedad.
CONCLUSIONES: Las intervenciones de música mejoran significativamente la ansiedad, la depresión, el dolor y la fatiga en pacientes con cáncer, especialmente los adultos. Música intervenciones fueron más eficaces en los adultos que en los niños o adolescentes y más eficaz cuando los pacientes, en lugar de los investigadores, eligieron la música.
IMPLICACIONES PARA LA PRÁCTICA: Nuestros resultados proporcionan información importante para los futuros planificadores de la música de la intervención para mejorar el diseño y los procesos que beneficiará a los pacientes en este tipo de programas.
Pediatric, adolescent, and young adult (PAYA) cancer survivors suffer from multiple domains of adverse psychosocial and behavioral outcomes during and after their cancer treatment. This study conducted a systematic review and metaanalysis of psychosocial, behavioral, and supportive interventions for PAYA cancer survivors.
METHODS:
We searched 11 electronic databases, 4 professional websites, and manual search of reference lists in existing reviews. We selected randomized controlled trials and controlled trials without randomization focusing on PAYA cancer survivors across six outcome domains.
RESULTS:
We included 61 studies (4,402 participants) published between 1987 and 2020. Overall risk of bias across studies was low. We identified an overall moderate and statistically significant treatment effect size for PAYA cancer survivors across six outcome domains.
CONCLUSION:
psychosocial, behavioral, and supportive interventions were overall effective for PAYA cancer survivors. However, interventions were not effective for certain outcome domains, and less effective among AYA versus pediatric cancer survivors.
