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AnteayerJournal of Clinical Nursing

The Effectiveness of Telemedicine on Distress, Physical Function and Self‐Efficacy in Patients With Cancer: A Meta‐Analysis of Randomised Controlled Trials

ABSTRACT

Background

Cancer is a major social, public health and economic problem worldwide, causing physical and psychological distress to patients. The emerging telemedicine model in healthcare delivery has garnered significant interest because of its potential effectiveness.

Objective

To assess the effects of telemedicine on distress, physical function, and self-efficacy in cancer patients.

Design

This meta-analysis was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 checklist.

Methods

Six databases were searched for relevant studies published from inception to October 2024. The literature search and data collection were conducted by two separate researchers. The quality of the methodologies in the studies included was evaluated using the Cochrane Risk of Bias Tool. Data analysis was conducted using Review Manager (version 5.4).

Result

Compared with the control group, patients who received telemedicine experienced significant reductions in distress (SMD = −0.44, 95% CI: −0.62 to −0.25, p < 0.00001, I 2 = 46%) and significant increases in physical function (SMD = 0.11, 95% CI: 0.01–0.22, p = 0.04, I 2 = 0%) and self-efficacy (SMD = 0.46, 95% CI: 0.23–0.69, p < 0.0001, I 2 = 0%).

Conclusion

Telemedicine can effectively enhance the psychological health and physiological function of cancer patients, as well as their self-efficacy, suggesting a sustainable approach to the clinical care of cancer patients. Future studies are needed to further investigate the effectiveness of telemedicine interventions in different types of cancer patients and in different cultural contexts and to conduct long-term follow-up studies to evaluate their long-term effectiveness and cost-effectiveness.

Clinical Relevance

This systematic review and meta-analysis provides evidence to offer effective and sustainable telemedicine care among cancer patients.

Patient and Public Contribution

No patient or public contribution.

Trial Registration

This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD42024604929) under the title ‘The effectiveness of death education on death anxiety, depression and quality of life in patients with advanced cancer: A meta-analysis of randomised controlled trials’. The full study protocol could be obtained at https://www.crd.york.ac.uk/PROSPERO/view/CRD42024604929

Efficacy of nonpharmacological interventions for severe radiation‐induced oral mucositis among head and neck cancer patients: A network meta‐analysis of randomised controlled trials

Abstract

Aims and Objectives

To assess the effectiveness of different nonpharmacological treatments for severe radiation-induced oral mucositis in patients with head and neck cancer.

Background

Radiation-induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation-induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear.

Design

Systematic review and network meta-analysis based on the PRISMA-NMA guidelines.

Methods

Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta-analysis was performed by R Studio. A network meta-analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation-induced oral mucositis in patients with head and neck cancer.

Results

Fifty-two studies involving seven types of nonpharmacological interventions were enrolled. The network meta-analysis indicated that natural plant-based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation-induced oral mucositis. For reducing the incidence of severe oral mucositis-related pain, the pairwise meta-analysis showed that only natural plant-based therapies and health education interventions were effective.

Conclusions

Nonpharmacological interventions are effective in the management of severe radiation-induced oral mucositis among patients with head and neck cancer.

Relevance to clinical practice

Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice.

Trial registration details

CRD42023400745.

Predictors of changes in resilience among spousal caregivers of patients with advanced cancer within the first 6 months after initial treatment

Abstract

Background

While previous research has established that resilience is affected by various factors, these studies have primarily focussed on individual variables associated with resilience, without providing insights into how to influence the rate of change in resilience.

Aim

To examine the trajectory of resilience and identify the factors associated with changes in resilience among spousal caregivers of patients with newly diagnosed advanced cancer receiving treatment during the first 6 months.

Design

An observational longitudinal study.

Methods

A total of 312 spousal caregivers of patients with newly diagnosed advanced cancer were recruited from January 2022 to December 2022 in Yancheng, China. Three data collection points were established, spanning from the first month to 6 months after initial cancer treatment. A latent growth model was employed to depict the resilience trajectory at various time points. A latent growth model with time-invariant covariates was adopted to determine the factors influencing resilience trajectory. The study adhered to the STROBE checklist for proper reporting.

Results

Throughout the follow-up period, the participants experienced a significant increase in resilience. Gender, family income, the patient's health status, spirituality and belief in familism were significantly associated with the baseline resilience level. Moreover, family income, the patient's health status, spirituality, caregiver burden and belief in familism were significantly associated with the rate of resilience change over time.

Conclusions

Spousal caregivers demonstrated a linear increase in resilience during the first 6 months after initial treatment. Meanwhile, changes in resilience were influenced by multiple factors during the early phase of cancer treatment. Thus, more attention should be paid to early identification and implementation of targeted interventions.

Relevance to Clinical Practice

Healthcare professionals should understand the change in resilience among spousal caregivers and conduct timely mental health interventions to enhance the resilience of families affected by cancer.

Patient or Public Contribution

The Guidance for Reporting Involvement of Patients and the Public-Short Form reporting checklists were used to improve patient and public involvement.

Caregiver burden among family caregivers of patients with advanced cancer in a palliative context: A mixed‐method study

Abstract

Aim

To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context.

Design

A sequential, explanatory, mixed-method study was performed.

Methods

Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third-level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor–Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi-structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following-a-thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden.

Results

The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta-themes and nine meta-subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID-19 and spousal relationship with patients) and factors that mitigate burden (social support).

Conclusion

Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family-centred palliative care must be further developed.

Implications for the profession

It is important to develop family-centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture-oriented death education in palliative units.

Impact

This study adopted a mixed-method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context. Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent. The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family-centred care in Chinese palliative units.

Reporting Method

The results of this study are reported based on the guidelines of the Mixed-Methods Article Reporting Standards.

Patient or Public Contribution

Eligible caregivers were invited to participate in the study and semi-structured interviews. Nurse managers of the palliative unit helped us access the patient-management system.

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