以系統性文獻綜整減輕癌症家庭照顧者焦慮及憂鬱之組合式護理措施

A Systematic Review of the Bundle Care for Reducing Anxiety and Depression for Cancer Family Caregivers

10.6530/YYN/2017.5.1

蘇僅涵(Chin-Han Su)；蔣立琦(Li-Chi Chiang)

癌症 ； 家庭照顧者 ； 介入措施 ； 憂鬱焦慮 ； cancer ； family caregiver ； intervention ； anxiety ； depression

源遠護理

11卷1期（2017 / 03 / 01）

5 - 11

繁體中文

背景：癌症家庭照顧者最常出現焦慮及憂鬱之心理困擾，近年陸續有針對癌症家庭照顧者之相關介入措施研究，而國內尚未有完整之系統性回顧綜整其成效。目的：本文以系統性文獻回顧進行隨機臨床試驗研究之發表文章搜尋及評讀，綜整癌症家庭照顧者之相關介入措施，以減輕癌症照顧者心理困擾之成效。方法：以系統性文獻回顧，於PubMed、Cochrane library、CINAHL、Medline、CEPS等資料庫進行搜尋，依據關鍵字及同義字之MeSH term：cancer, caregiver, family caregiver, intervention, program, training, depression, anxiety，限定文章為隨機臨床控制試驗（randomized control trial）之研究，納入條件為西元2004-2016年、成人癌症之家庭照顧者；排除條件為非中英文之文章，兒童癌症之家庭照顧者及臨終癌症之家庭照顧者之研究。共納入8篇文章進行評讀及分析。結果：8篇隨機臨床控制試驗之研究，共有5種介入措施緩解癌症家庭照顧者之憂鬱及焦慮，分別為心理社會介入措施、以需求為導向介入措施、認知行為治療、問題處理策略、行為治療，以及放鬆技巧介入措施。綜整幾點重要護理可以主導的措施，包含需求評估、角色關係維持、壓力管理、自我保護、症狀管理等。本文可提供改善癌症家庭照顧者憂鬱及焦慮之臨床照護參考，以利臨床護理人員協助癌症家庭照顧者於照顧期間減輕其心理困擾。

Background: Anxiety and depression are most common psychological distress of cancer family caregivers. The relative nursing interventional studies for cancer family caregivers were reported in recently, but lack of a systematic review for knowledge synthesis. Purpose: We reviewed published randomized clinical trials and conducted a systematic review of nursing interventions to reduce depressive and anxiety for cancer family caregivers. Methods: We searched for relevant studies from PubMed, Cochrane library, CINAHL, Medline, and CEPS. Inclusion criteria included randomized controlled design, relative nursing interventions in reducing anxiety and depression of cancer family caregiver of adult patients. The published articles focused only from 2004 to 2016, and limited in English language. Exclusion criteria included cancer family caregiver of child or the hospice care. Eleven articles were retracted for further appraisal, analysis and synthesis. Results: Finally, eight randomized clinical trials were selected for analysis with good quality. We synthesized five type interventions for reducing anxiety and depression of cancer family caregiver in adult patients, that including (1) needs-based care, (2) psychosocial interventions, (3) cognitive behavioral therapy, (4) problem-solving intervention and (5) stress management. We integrated the main concepts of nurse-led interventions included: needs assessment, maintenance role relationship, self-protection, symptom management, and stress management. These could provide the bundle nursing care strategies for reducing anxiety and depression of cancer family caregiver. Oncology nurses could help cancer family caregivers to share decision making in selecting the appropriate interventions for reducing psychological distress.

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