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To critically assess the impact of theory-guided positive psychological interventions on the quality of life of breast cancer patients and survivors.
Systematic review and meta-analysis.
A comprehensive literature search was conducted across seven electronic databases from inception to August 2024. Randomised controlled trials that examined the effects of theory-guided positive psychological interventions on adult breast cancer patients or survivors and reported quality of life outcomes were included. Screening, data extraction and critical appraisal were independently performed by the reviewers using the revised Cochrane risk-of-bias tool (RoB2). A meta-analysis was conducted using RevMan Web. The study was reported following the PRISMA 2020 Statement.
Five randomised controlled trials were included. Only two of these studies showed a low risk of bias across all quality measures. The meta-analysis demonstrated a significant improvement in quality of life following theory-guided positive psychological interventions, with low heterogeneity. Subgroup analyses revealed that interventions lasting either less than or longer than 3 weeks, and both group-based and individual-based formats, had positive effects on quality of life. Additional psychological benefits were observed including reductions in depressive symptoms, anxiety, perceived stress and improvements in post-traumatic growth, resilience, hope and perceived benefits. One study also reported improvements in sleep quality.
The findings demonstrate that theory-guided positive psychological interventions can potentially significantly improve quality of life in breast cancer patients. However, the limited number of studies underscores the need for further high-quality research to validate these findings and identify the most effective intervention characteristics.
Our systematic review highlights that theory-guided positive psychological interventions show promise as an effective strategy for improving the quality of life in breast cancer patients. These interventions can enhance psychosocial support strategies, paving the way for better-informed approaches that lead to improved patient outcomes.
No patient or public contribution.
The systematic review and meta-analysis had been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration ID number: CRD42024581382
Disease severity negatively affects health-related quality of life (HRQOL) among people with heart failure (HF). However, the underlying mechanisms remain underexplored. Illness perceptions and depression serve as potential mediators of this relationship, but the evidence supporting this is limited.
To investigate the relationships among disease severity, illness perceptions, depression and HRQOL in people with HF, as well as to explore the mediating roles of illness perceptions and depression in the relationship between disease severity and HRQOL.
People with HF were recruited from a tertiary hospital in China between January and May 2023. All the participants were assessed for disease severity, illness perceptions, depression, HRQOL and sociodemographic and clinical characteristics. The mediation analysis was performed using PROCESS macro in SPSS. The STROBE checklist was followed.
This study recruited 164 subjects. Disease severity had a significant total effect on HRQOL (β = 0.716, 95% CI: 4.475, 12.068). The results showed that illness perceptions mediated the relationship between disease severity and HRQOL (β = 0.172, 95% CI: 0.042, 0.337), accounting for 24.02% of the total effect. However, a significant mediating role of depression in this relationship was not found. Furthermore, we found that illness perceptions and depression sequentially mediated the relationship between disease severity and HRQOL (β = 0.194, 95% CI: 0.005, 0.395), which accounted for 27.09% of the total effect.
The effect of disease severity on HRQOL is sequentially mediated by illness perceptions and depression. Illness perceptions are important predictors of HRQOL. Targeted interventions should be employed to improve illness perceptions, thereby enhancing HRQOL among people with HF.
Medical staff can carefully assess patient's illness perceptions and implement appropriate strategies to enhance these illness perceptions, thereby improving their HRQOL.
No patient or public contribution.
To estimate the effects of nurse-led self-care interventions on people with heart failure (HF).
Research evidence of the effects of nurse-led HF self-care interventions on patient outcomes is scant.
A systematic review and meta-analysis of randomised controlled trials (RCTs).
Six databases (MEDLINE, Embase, Web of Science, CENTRAL, CINAHL and PsycINFO) were searched from the inception to December 2022 to identify eligible studies.
RCTs published in English that evaluated the impact of nurse-led HF self-care interventions on quality of life, anxiety, symptom burden, sleep quality, healthcare service utilisation and mortality were included. The risk of bias in included studies was assessed using RoB 2.0. We conducted data syntheses using the R software and graded the quality of the evidence using the GRADE approach. The systematic review was conducted in accordance with the PRISMA.
Twenty-five studies with 2746 subjects were included. Our findings demonstrated, that compared to the controls, nurse-led self-care interventions improved QOL (SMD: .83, 95% CI: .50–1.15, moderate evidence), anxiety (MD: 1.39, 95% CI: .49–2.29, high evidence) and symptom burden (SMD: .81, 95% CI: .24–1.38, low evidence) in people with HF. No significant effects were found in all-cause hospital readmission and all-cause emergency department visit. Research evidence on sleep quality, cardiac-related hospital readmission, cardiac-related emergency department visit and all-cause mortality remained unclear.
Our review suggests that nurse-led HF self-care interventions have favourable effects on the QOL, anxiety and symptom burden. Further, well-designed RCTs are warranted to address the gaps identified in this review.
The results indicated that nurse-led HF self-care interventions could improve QOL, anxiety and symptom burden in people with HF. Nurse-led self-care intervention could be integrated into current HF management practices.
The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation.
Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi-ethnic country.
A cross-sectional study design.
A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE-Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS).
Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self-driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face-to-face, centre-based cardiac rehabilitation approach.
Several barriers were associated with non-participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home-based and hybrid cardiac rehabilitation may represent potential solutions to improve participation.
By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation.
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