The experience of adults who choose watchful waiting or active surveillance as an approach to medical treatment: a qualitative systematic review.
The experience of adults who choose watchful waiting or active surveillance as an approach to medical treatment: a qualitative systematic review.
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DOI：
10.11124/jbisrir-2016-2270
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发表时间：
2016-02-01
期刊：
影响因子：
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通讯作者：
Moore, Ellen
中科院分区：
文献类型：
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作者：
Rittenmeyer, Leslie;Huffman, Dolores;Moore, Ellen
背景：“观察等待”或“主动监测”是某些疾病医疗管理的另一种方法。最常被认为适合作为低风险前列腺癌的治疗方法，在乳腺癌监测、尿路结石、淋巴细胞白血病、抑郁症和小肾肿瘤的文献中也发现了这种方法。 目的：本系统评价旨在：确定并综合关于选择观察等待或主动监测作为医疗方法的成年人经验的最佳可用国际证据。为此，本次审查提出的问题是： 1．选择观察等待或主动监测的患者如何描述做出决定的过程？2.影响他们做出选择的因素有哪些？3．选择观察等待或主动监测的患者如何描述这种经历？纳入标准：男性或女性患者，18 岁或以上，经历过选择或不选择观察等待或主动监测作为治疗方法的现象。感兴趣的现象是对选择观察等待或主动监测作为医疗方法的成年患者的经历的描述。本综述考虑了侧重于定性数据的研究，包括但不限于现象学、扎根理论、民族志、行动研究和批判理论。还考虑了叙述性描述和患者声音的混合方法研究。研究报告和论文等灰色文献也包括在内。 搜索策略：搜索策略旨在通过电子数据库、参考文献列表和万维网查找已发表和未发表的研究。对相关数据库进行了广泛的检索，包括 CINAHL、PubMed、SCOPUS 和 PsycINFO。审查的每个部分都使用了三步搜索策略。研究仅限于英语论文。检索考虑了 2000 年至 2015 年 1 月的论文。 方法论质量：选择检索的定性论文在纳入评审之前，由两名独立评审员评估了方法学有效性，使用乔安娜·布里格斯研究所定性评估和评审工具 (JBI-QARI) 的标准化批判性评估工具。审稿人之间出现的任何分歧均通过讨论或与第三位审稿人解决。数据提取：使用标准化数据提取工具从审稿中包含的论文中提取定性数据。提取的数据包括有关描述与评论问题相关的经历的感兴趣现象的具体细节数据合成：数据是使用 Joanna Briggs Institute 方法通过使用 JBI-QARI 软件和方法进行元聚合来合成的。结果：总共 16 项研究被纳入最终评论，这些研究经过两名独立评审员的严格评估并被认为是高质量的。评估后一项研究被排除。 16 项研究中的 155 项发现被提取为 10 个类别，然后分为 3 个综合发现。综合研究结果阐明：结论：审查的综合结果表明，做出选择观察等待的决定的过程是复杂的。在这个过程中，患者和他们的重要他人会经历一系列的情绪，这些情绪往往会导致不确定性和焦虑。一旦做出决定，患者必须接受他们的诊断令人不安的事实，并做出必要的调整。与医疗保健从业者建立同理心、令人放心的关系可以减轻这一过程的负担。医疗保健提供者需要认识到，并非所有患者都对选择观察等待的决定感到“平静”。在此期间，不确定性和恐惧以及压力和焦虑感可能会加剧。患者和他们的重要他人经常尝试以他们知道的最佳方式适应，但需要评估他们应对策略的有效性。此外，医疗保健提供者还需要意识到，随着与观察等待相关的焦虑和压力的增加，患者对医疗保健信息的理解和提问的能力可能会降低。医疗服务提供者和患者都可以从与决策和生活相关的不确定性和恐惧的许多方面的公开讨论中受益。建议采用共享决策模型来管理决策和接受决策所产生的一系列问题。患者似乎非常敏感地意识到他们所接受的护理是否缺乏同理心。开放、同理心和非评判性的沟通至关重要。需要表达讨论性功能等敏感问题的意愿。最后，提供者及其工作人员需要继续关注阐明情况中充满希望和乐观的方面的重要性，因为许多患者在就诊期间从非语言和语言互动中获取有关其健康状况的线索。未来的研究应该进行调查。
BACKGROUND: "Watchful waiting" or "active surveillance" is an alternative approach in the medical management of certain diseases. Most often considered appropriate as an approach to treatment for low-risk prostate cancer, it is also found in the literature in breast cancer surveillance, urinary lithiasis, lymphocytic leukemia, depression and small renal tumors.OBJECTIVES: This systematic review sought to:Identify and synthesize the best available international evidence on the experience of adults who choose watchful waiting or active surveillance as an approach to medical treatment. To this end the questions addressed in this review were:1. How do patients who have chosen watchful waiting or active surveillance describe the process of coming to the decision?2. What were the factors that influenced their decision to choose?3. How do patients who have chosen watchful waiting or active surveillance describe the experience?INCLUSION CRITERIA: Male or female patients, 18 years or older, who experience the phenomenon of choosing or not choosing watchful waiting or active surveillance as a treatment approach.The phenomena of interest were accounts of the experiences of adult patients who choose watchful waiting or active surveillance as an approach to medical treatment.This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and critical theory. Mixed method studies with narrative description and patient voice were also considered. Grey literature such as research reports and dissertations were also included.SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies through electronic databases, reference lists, and the World Wide Web. Extensive searches were undertaken of relevant databases to include CINAHL, PubMed, SCOPUS and PsycINFO. A three-step search strategy was used in each component of the review. Studies were limited to English language papers. The search considered papers from the year 2000 to January 2015.METHODOLOGICAL QUALITY: Qualitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer.DATA EXTRACTION: Qualitative data were extracted from papers included in the review using the standardized data extraction tool from. The data extracted included specific details about the phenomena of interest that described the experiences pertinent to the review questionsDATA SYNTHESIS: The data were synthesized using the Joanna Briggs Institute approach to meta-synthesis by meta-aggregation using the JBI-QARI software and methods.RESULTS: A total of 16 studies, critically appraised by two independent reviewers and deemed to be of high quality, were included in the final review. One study was excluded after appraisal. One hundred and fifty-five findings from the 16 studies were extracted into 10 categories and then into three synthesized findings. The synthesized findings explicated:CONCLUSIONS: The synthesized findings of the review conclude that the process of making the decision to choose watchful waiting is complex. Through the process patients and their significant others experience an array of emotions that often lead to uncertainty and anxiety. Once the decision is made patients must cope with the knowledge that they have a troubling diagnosis and make the necessary adjustments. An empathic, reassuring relationship with a healthcare practitioner eases the burden of this process.Healthcare providers need to recognize that not all patients are "at peace" with the decision of choosing watchful waiting. Uncertainty and fear may intensify during this time as well as feelings of stress and anxiety. Patients and their significant others often attempt to adapt in the best way they know how but the effectiveness of their coping strategies needs to be assessed. In addition, healthcare providers need to also be aware that with the increased anxiety and stress associated with watchful waiting, patients' understanding of healthcare information and the ability to ask questions may be diminished. Both providers and patients benefit from open discussions related to the many aspects of uncertainty and fear related to making and living with the decision. Employing a shared decision making model with regard to the management of the array of issues that comes from both making the decision and living with it is recommended. It appears that patients are very sensitive to recognizing when the care they are receiving lacks empathy. Communication that is open, empathic, and non-judgmental is essential. A willingness to discuss sensitive issues such as sexual function needs to be conveyed. Lastly, providers and their staff need to remain attentive to the importance of articulating aspects of the situation that are hopeful and optimistic as many patients, during their visits, take their cues regarding their health status from non-verbal and verbal interactions.Future studies should investigate.