Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis.
Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis.
复制标题
癌症幸存者在远程医疗方面的经验：系统评价和主题综合。
DOI：
10.2196/jmir.6575
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发表时间：
2017-01-09
影响因子：
7.4
通讯作者：
Ream E
中科院分区：
文献类型：
--
作者：
Cox A;Lucas G;Marcu A;Piano M;Grosvenor W;Mold F;Maguire R;Ream E
全世界癌症的净存活率正在上升，给保健服务的提供带来了压力。有一种将癌症幸存者的护理转移到社区的动力，鼓励他们在自己的护理中发挥积极作用。远程医疗，在患者和医疗保健专业人员（HCP）之间远程交换数据和通信的技术的使用，是这一不断发展的护理模式的重要贡献者。远程保健干预措施是“复杂的”，了解患者的经验对评估其影响很重要。然而，由于详细介绍癌症幸存者参与远程保健的定性研究尚未合成，因此缺乏对患者体验的更广泛的看法。系统地识别，评估和综合定性研究证据的经验，成年癌症幸存者参与远程医疗干预，远程医疗干预的特点，这组病人的经验。于2015年8月14日和2016年3月8日检索了Medline（PubMed）、PsychINFO、护理和相关卫生专业人员累积索引（CINAHL）、Embase和科克伦对照试验中心注册库，以查找2006年至2016年期间发表的英文论文。入选标准如下：18岁及以上的成年癌症幸存者、癌症诊断、参与远程医疗干预（定义为通过电话、互联网或手持或移动的技术与HCP进行远程通信或远程监测）的经验，以及报告定性数据（包括逐字引用）。一个适应的关键评价技能计划（CASP）的清单，定性研究被用来评估论文质量。每篇纳入文章的结果部分逐行编码，所有论文都进行了归纳分析，包括比较，重新检查和代码分组以开发描述性主题。分析性主题是通过反复思考和解释研究内部和研究之间的描述性主题而制定的。在纳入的22篇论文中，出现了3个分析主题，每个主题有3个描述性子主题：（1）远程医疗对癌症幸存者中断生活的影响（方便、独立和负担）;（2）跨越物理距离的个性化护理（时间、空间和人的因素）;以及（3）远程再保证-医疗保健专业连接的安全网（主动连接、被动连接和通过该网的滑动）。远程保健干预是一种方便的方法，有可能最大限度地减少治疗负担和对癌症幸存者生活的干扰。远程保健干预措施可以为癌症患者和癌症以外的人提供个性化的护理和保证;但是，在定制干预措施时必须考虑个人因素，以确保参与促进益处而不是负担。远程保健干预措施可以为癌症幸存者提供独立性和保证。未来的远程保健干预措施需要与广泛的癌症幸存者合作反复开发，以最大限度地提高参与度和效益。
Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors—individuals living with and beyond cancer—to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are “complex,” and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies. Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance—a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors’ lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden. Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit.