研究背景：婦科癌症的診斷及各種相關的治療，對性功能、生活質素及心理健康都有負面的影響。文獻指出心理教育對婦科癌症病人這方面的影響有正面的效果，但是效用的証據並不一致。 / 系統化綜述: 本研究首先進行系統化綜述，並根據喬安娜．布里格斯的方法進行，目的在於確定心理教育對婦科癌症病人的性功能、生活質素及心理健康的功效，以及辨認一套有效的心理教育課程給予婦科癌症病人。總共有十一份隨機控制實驗的文獻，包括九百七十五位婦科癌症病人，被納入本綜述，其中四份可比較的文獻進行了薈萃分析。根據兩份評估心理教育對抑鬱功效的文獻薈萃結果顯示，心理教育對改善抑鬱徵狀有顯著的改善。另外兩份文獻評估心理教育對生活質素的功效，薈萃結果顯示心理教育對身理方面的生活質素未有明顯的改善，相反地，提供資訊性的教育對婦科癌症病人心理方面的生活質素有明顯的功效。關於心理教育對性功能的功效，似乎對性生活有所改善，但是並未能在性功能的評估工具反映出來。關於心理教育對心理健康的功效，除了抑鬱以外，似乎未有足夠的証據顯示有顯著的功效。系統化綜述建議心理教育予婦科癌症病人應包括三種元素：資訊提供、行為治療及心理支持；形式可以是個人、個人及伴侶共同參予、或小組；應由護士提供；於癌症治療開始前進行，直至出院後；包括四堂課程，每堂三十分鐘至一小時完成。 / 試驗性研究目的：試驗性研究目的是測試提供一套根據系統化綜述結果設計的心理教育予香港婦科癌症病人的可行性，以及評估該課程對改善香港婦科癌症病人的性功能、生活質素、及心理健康的功效。 / 試驗性研究方法：試驗性研究採用隨機控制實驗的方法，把二十六位婦科癌症病人分配到兩個不同的組別。實驗組的參加者，接受一套心理教育；對照組的參加者於實驗組的同一時段收到研究員的訪問。不論哪個組別的參加者，都會進行指標評估，包括性功能、生活質素、不明朗、社交支持、焦慮及抑鬱的狀況。研究指標分別在手術前(T0)、手術後及住院期間(T1)，和手術後8星期(T2)。實驗組的參加者及於臨床工作的護士更會被邀請進行了簡單的傾談，從而了解她們對此心理教育的意見及感受。非參數統計推斷方法用以檢驗組內和組間於上述各指標的差異。實驗組的參加者及護士參予的面談，會進行錄音及內容分析。 / 研究結果：於兩組之間的比較，實驗組的參加者對疾病資料的不一致，有顯著的改善。但是，兩組之間的性功能、生活質素、不明朗、社交支持、焦慮及抑鬱均未有顯著的分別。參加者於面談中指出，心理教育可減低婦科癌症病人的壓力，對她們來說有著實際的用途。 / 研究結論：系統化綜述顯示心理教育對婦科癌症病人有正面的功效。雖然試驗性研究的定量資料結果指出心理教育對香港的婦科癌症病人，除了對疾病資料的不一致有所改善外，在其他各方面的評估，均未有顯著的功效，但是，品質數據的結果顯示婦科癌症病人確實需要心理教育，而此教育於臨床環境實行是可行的。 / Background: A diagnosis and treatment of gynecological cancer (GC) has adverse effects on the sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions (PEIs) are recommended for GC patients to improve their outcomes, but evidence for their effectiveness is far from conclusive. / Systematic review: A systematic review was first carried out according to the Joanna Briggs Institute (JBI) approach to identify the best available evidence relating to the effectiveness of PEIs for GC patients in sexual functioning, quality of life and psychological outcomes. A total of 11 randomized controlled trials (RCTs) involving 975 GC patients were included in the systematic review, but only four comparable studies were appropriate for meta-analysis. PEIs significantly improved depressive symptoms, standardized mean difference (SMD) = -0.80, 95% CI [-1.05 to -0.54], p = < .00001, among the patients. However, there was no significant benefit to the physical aspect of quality of life, SMD = -0.12, 95% CI [-0.45 to 0.20], p = .46. Conversely, information-only therapy demonstrated significant effects on the mental aspects of quality of life, SMD = -0.41, 95% CI [-0.74 to -0.08], p = .01. In addition, from qualitative data, PEIs appeared to be helpful in improving sexual life, but changes in sexual functioning scores were not statistically significant. The interventions appeared to have only limited beneficial effect on anxiety, distress, adjustment to illness and uncertainty, and had no significant effect in improving mood, self-esteem or ability to cope. The review also suggested that PEIs for GC patients would incorporate information provision, behavior therapy and psychological support. The format might be individual, with or without a partner’s participation, or in a group. A nurse was found to be the ideal provider. The interventions could be arranged at the start of cancer treatment and then be continued after discharge, and the number of sessions might be four, each lasting between 30 minutes and one hour. / Aim of pilot study: A program of PEIs was designed based on the systematic review, and piloted on Hong Kong GC patients to test the feasibility and effectiveness of implementing the interventions in Hong Kong. / Pilot research plan: The pilot study was a single-blinded RCT and mix-method design. Twenty-six subjects were randomly assigned to either the intervention or attention control group. The intervention group received the program of PEIs, while the attention control group received attention from the researcher over the same period. Data collection was carried out at baseline (T0), after the operation and during the in-hospital period (T1) and eight weeks after the operation (T2). Qualitative data was collected from the intervention group and nurses working in the clinical setting at T2. Non-parametric tests were used to compare the baseline and various outcome variables within and between groups. Audio-tapes of semi-structured interviews were transcribed verbatim, and content analysis was performed to identify significant themes. / Key findings of pilot study: Participants in the intervention group had statistically significantly less inconsistent information on illness than the attention control group, but there were no statistically significant differences in all other outcome variables including sexual functioning, quality of life, uncertainty, social support, anxiety and depression. Qualitative data from the participants indicated the program of PEIs reduced their stress level and was useful. / Conclusion: The systematic review demonstrated evidence of the positive effects of PEIs on GC patients. Although there were no significant effects appearing in most quantitative results of the intervention program in the pilot study, the qualitative results indicated that the interventions were found desirable by Hong Kong GC patients. Nurses identified implementing the program as feasible in clinical settings. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chow, Ka Ming. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 185-204). / Abstracts also in Chinese; appendixes includes Chinese. / Chapter CHAPTER 1 --- INTRODUCTION / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Aims and significance of the study --- p.4 / Chapter 1.3 --- Overview of the thesis --- p.4 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Chapter 2.1 --- Introduction --- p.6 / Chapter 2.2 --- Impact of GC on sexual functioning --- p.6 / Chapter 2.2.1 --- Mixed types of GC --- p.7 / Chapter 2.2.2 --- Ovarian cancer --- p.10 / Chapter 2.2.3 --- Cervical cancer --- p.11 / Chapter 2.2.4 --- Impact of GC on sexual functioning in Chinese culture --- p.15 / Chapter 2.3 --- Impact of GC on quality of life --- p.18 / Chapter 2.3.1 --- Mixed types of GC --- p.19 / Chapter 2.3.2 --- Cervical cancer --- p.21 / Chapter 2.3.3 --- Impact of GC on quality of life in Chinese culture --- p.24 / Chapter 2.4 --- Impact of GC on psychological well-being --- p.25 / Chapter 2.4.1 --- Mixed types of GC --- p.26 / Chapter 2.4.2 --- Cervical cancer --- p.29 / Chapter 2.4.3 --- Impact of GC on psychological well-being in Chinese culture --- p.30 / Chapter 2.5 --- Current nursing practice on sexuality with GC patients --- p.30 / Chapter 2.5.1 --- Attitudes of health-care professionals towards sexuality --- p.31 / Chapter 2.5.2 --- Information needs of GC patients --- p.33 / Chapter 2.5.3 --- Sexuality assessment --- p.35 / Chapter 2.5.4 --- Sexuality interventions --- p.37 / Chapter 2.6 --- Psychoeducational interventions (PEIs) --- p.38 / Chapter 2.6.1 --- Theoretical background --- p.38 / Chapter 2.6.2 --- Effects of PEIs on cancer patients --- p.40 / Chapter 2.6.3 --- Effects of PEIs on GC patients --- p.42 / Chapter 2.7 --- Summary --- p.44 / Chapter CHAPTER 3 --- SYSTEMATIC REVIEW (PHASE I) / Chapter 3.1 --- Introduction --- p.46 / Chapter 3.2 --- Review objectives and questions --- p.46 / Chapter 3.3 --- Inclusion criteria --- p.48 / Chapter 3.3.1 --- Types of studies --- p.48 / Chapter 3.3.2 --- Types of participants --- p.48 / Chapter 3.3.3 --- Types of interventions --- p.48 / Chapter 3.3.4 --- Types of outcome measures --- p.49 / Chapter 3.4 --- Search strategy --- p.50 / Chapter 3.5 --- Methods of the review --- p.52 / Chapter 3.5.1 --- Assessment of methodological quality --- p.52 / Chapter 3.5.2 --- Data extraction --- p.52 / Chapter 3.5.3 --- Data synthesis --- p.53 / Chapter 3.6 --- Systematic review results --- p.54 / Chapter 3.6.1 --- Description of studies’ retrieval and selection --- p.54 / Chapter 3.6.2 --- Methodological quality of the included studies --- p.57 / Chapter 3.6.2.1 --- Randomization --- p.57 / Chapter 3.6.2.2 --- Blinding --- p.57 / Chapter 3.6.2.3 --- Consent and completion rates --- p.58 / Chapter 3.6.2.4 --- Power estimation --- p.58 / Chapter 3.6.2.5 --- Result data --- p.58 / Chapter 3.6.3 --- Details of the included studies --- p.59 / Chapter 3.6.3.1 --- Country of origin --- p.59 / Chapter 3.6.3.2 --- Samples --- p.59 / Chapter 3.6.3.3 --- Components of PEIs --- p.59 / Chapter 3.6.3.4 --- Comparison group --- p.61 / Chapter 3.6.3.5 --- Format of PEIs --- p.62 / Chapter 3.6.3.6 --- Provider of PEIs --- p.62 / Chapter 3.6.3.7 --- Provision time frame of PEIs --- p.63 / Chapter 3.6.3.8 --- Duration of PEIs --- p.63 / Chapter 3.6.3.9 --- Outcome measurements --- p.64 / Chapter 3.6.4 --- Effects of PEIs on outcomes --- p.64 / Chapter 3.6.4.1 --- Sexual functioning --- p.65 / Chapter 3.6.4.2 --- Quality of life --- p.65 / Chapter 3.6.4.3 --- Psychological outcomes --- p.68 / Chapter 3.6.4.3.1 --- Anxiety and depression --- p.68 / Chapter 3.6.4.3.2 --- Distress --- p.70 / Chapter 3.6.4.3.3 --- Adjustment to illness --- p.71 / Chapter 3.6.4.3.4 --- Mood --- p.71 / Chapter 3.6.4.3.5 --- Self-esteem --- p.72 / Chapter 3.6.4.3.6 --- Uncertainty --- p.72 / Chapter 3.6.4.3.7 --- Coping --- p.72 / Chapter 3.6.4.4 --- Brief summary --- p.72 / Chapter 3.6.5 --- Design of PEIs --- p.73 / Chapter 3.6.5.1 --- Effective components --- p.73 / Chapter 3.6.5.2 --- Effective format --- p.75 / Chapter 3.6.5.3 --- Effective provider --- p.76 / Chapter 3.6.5.4 --- Effective provision time frame --- p.76 / Chapter 3.6.5.5 --- Effective duration --- p.77 / Chapter 3.7 --- Discussion --- p.78 / Chapter 3.7.1 --- Effects of PEIs on sexual functioning --- p.80 / Chapter 3.7.2 --- Effects of PEIs on quality of life --- p.82 / Chapter 3.7.3 --- Effects of PEIs on psychological outcomes --- p.84 / Chapter 3.7.3.1 --- Anxiety and depression --- p.84 / Chapter 3.7.3.2 --- Distress --- p.86 / Chapter 3.7.3.3 --- Adjustment to illness --- p.87 / Chapter 3.7.3.4 --- Mood --- p.87 / Chapter 3.7.3.5 --- Self-esteem --- p.88 / Chapter 3.7.3.6 --- Uncertainty --- p.88 / Chapter 3.7.3.7 --- Coping --- p.89 / Chapter 3.7.4 --- Design of PEIs --- p.89 / Chapter 3.7.4.1 --- Effective components and theories --- p.89 / Chapter 3.7.4.2 --- Effective format --- p.92 / Chapter 3.7.4.3 --- Effective provider --- p.93 / Chapter 3.7.4.4 --- Effective provision time frame --- p.93 / Chapter 3.7.4.5 --- Effective duration --- p.94 / Chapter 3.8 --- Summary of systematic review --- p.95 / Chapter 3.8.1 --- Implications for practice --- p.95 / Chapter 3.8.2 --- Implications for research --- p.97 / Chapter 3.9 --- Summary --- p.100 / Chapter CHAPTER 4 --- METHODOLOGY OF PILOT STUDY (PHASE II) / Chapter 4.1 --- Introduction --- p.102 / Chapter 4.2 --- Rationale for conducting a pilot study --- p.102 / Chapter 4.3 --- Aims and objectives --- p.103 / Chapter 4.4 --- Operational definition --- p.104 / Chapter 4.4.1 --- Psychoeducational interventions (PEIs) --- p.104 / Chapter 4.4.2 --- Sexual functioning --- p.105 / Chapter 4.4.3 --- Quality of life --- p.105 / Chapter 4.4.4 --- Uncertainty --- p.105 / Chapter 4.4.5 --- Anxiety --- p.106 / Chapter 4.4.6 --- Depression --- p.106 / Chapter 4.4.7 --- Social support --- p.106 / Chapter 4.5 --- Interventions --- p.107 / Chapter 4.5.1 --- Program of PEIs --- p.107 / Chapter 4.5.1.1 --- Theoretical framework underpinning the interventions --- p.107 / Chapter 4.5.1.2 --- Components of the program of PEIs --- p.113 / Chapter 4.5.1.2.1 --- Information provision --- p.113 / Chapter 4.5.1.2.2 --- Behavioral therapy --- p.113 / Chapter 4.5.1.2.3 --- Psychological support --- p.114 / Chapter 4.5.1.3 --- Design of the program of PEIs --- p.115 / Chapter 4.5.2 --- Attention control --- p.121 / Chapter 4.5.3 --- Usual care --- p.122 / Chapter 4.6 --- Methodology --- p.123 / Chapter 4.6.1 --- Study design --- p.123 / Chapter 4.6.2 --- Study setting --- p.125 / Chapter 4.6.3 --- Sample --- p.126 / Chapter 4.6.3.1 --- Sampling method --- p.126 / Chapter 4.6.3.2 --- Sample size determination --- p.127 / Chapter 4.6.3.3 --- Recruitment process --- p.128 / Chapter 4.7 --- Data collection --- p.129 / Chapter 4.7.1 --- Measures --- p.129 / Chapter 4.7.2 --- Study instruments --- p.130 / Chapter 4.7.2.1 --- Demographic data sheet --- p.130 / Chapter 4.7.2.2 --- Sexual functioning --- p.131 / Chapter 4.7.2.2.1 --- Justification for choosing the instrument --- p.134 / Chapter 4.7.2.3 --- Quality of life --- p.134 / Chapter 4.7.2.3.1 --- Justification for choosing the instrument --- p.136 / Chapter 4.7.2.4 --- Uncertainty --- p.136 / Chapter 4.7.2.4.1 --- Justification for choosing the instrument --- p.138 / Chapter 4.7.2.5 --- Social support --- p.139 / Chapter 4.7.2.5.1 --- Justification for choosing the instrument --- p.141 / Chapter 4.7.2.6 --- Anxiety and depression --- p.141 / Chapter 4.7.2.6.1 --- Justification for choosing the instrument --- p.143 / Chapter 4.7.2.7 --- Semi-structure interview --- p.144 / Chapter 4.7.2.7.1 --- Intervention recipients --- p.144 / Chapter 4.7.2.7.2 --- Health-care providers --- p.144 / Chapter 4.7.3 --- Data collection procedure --- p.145 / Chapter 4.8 --- Data analysis --- p.149 / Chapter 4.8.1 --- Quantitative data --- p.149 / Chapter 4.8.1.1 --- Comparison of baseline data --- p.151 / Chapter 4.8.1.2 --- Comparison of outcome variables --- p.151 / Chapter 4.8.2 --- Qualitative data --- p.153 / Chapter 4.9 --- Ethical considerations --- p.154 / Chapter 4.1 --- Summary --- p.155 / Chapter CHAPTER 5 --- RESULTS OF THE PILOT STUDY / Chapter 5.1 --- Introduction --- p.156 / Chapter 5.2 --- Recruitment of participants --- p.157 / Chapter 5.3 --- Characteristics of all participants --- p.159 / Chapter 5.3.1 --- Demographic and clinical characteristics --- p.159 / Chapter 5.3.2 --- Homogeneity of the participants --- p.161 / Chapter 5.4 --- Baseline outcome variables --- p.164 / Chapter 5.4.1 --- Baseline outcome variables of all participants --- p.164 / Chapter 5.4.2 --- Comparison of baseline outcome variables between intervention and attention control groups --- p.166 / Chapter 5.5 --- Outcome variables within-group changes --- p.168 / Chapter 5.5.1 --- Quality of life --- p.168 / Chapter 5.5.2 --- Uncertainty --- p.170 / Chapter 5.5.3 --- Social support --- p.174 / Chapter 5.5.4 --- Anxiety and depression --- p.179 / Chapter 5.6 --- Outcome variables between-group changes --- p.181 / Chapter 5.6.1 --- Sexual functioning --- p.181 / Chapter 5.6.2 --- Quality of life --- p.184 / Chapter 5.6.3 --- Uncertainty --- p.185 / Chapter 5.6.4 --- Social support --- p.187 / Chapter 5.6.5 --- Anxiety and depression --- p.190 / Chapter 5.7 --- Feasibility of implementing the PEI program in Hong Kong clinical settings --- p.191 / Chapter 5.7.1 --- Intervention recipients’ perspective --- p.191 / Chapter 5.7.1.1 --- Emotional support --- p.192 / Chapter 5.7.1.1.1 --- Offering psychology support --- p.192 / Chapter 5.7.1.1.2 --- Removing worries about sexual life --- p.192 / Chapter 5.7.1.2 --- Informational support --- p.193 / Chapter 5.7.1.2.1 --- Acquiring knowledge on illness --- p.193 / Chapter 5.7.1.2.2 --- Behavioral therapy helpful in post-operative care --- p.193 / Chapter 5.7.1.2.3 --- Resources available in the community --- p.194 / Chapter 5.7.1.3 --- Elements of the program --- p.194 / Chapter 5.7.1.3.1 --- Appropriate design of the interventions --- p.194 / Chapter 5.7.1.3.2 --- Content of information provided --- p.195 / Chapter 5.7.1.4 --- Feelings towards the program --- p.195 / Chapter 5.7.1.4.1 --- Appreciation of the interventions --- p.195 / Chapter 5.7.1.4.2 --- Lack of GC health education --- p.196 / Chapter 5.7.2 --- Health-care providers perspective --- p.196 / Chapter 5.7.2.1 --- Opinions regarding the program --- p.197 / Chapter 5.7.2.1.1 --- Quality of information provided --- p.197 / Chapter 5.7.2.1.2 --- Usefulness of the interventions --- p.197 / Chapter 5.7.2.2 --- Suggestions for improvement --- p.198 / Chapter 5.7.2.2.1 --- Content of information provided --- p.198 / Chapter 5.7.2.2.2 --- Format of the interventions --- p.199 / Chapter 5.7.2.2.3 --- Coverage of the patient population --- p.199 / Chapter 5.7.2.3 --- Feasibility of implementing the program in Hong Kong --- p.200 / Chapter 5.7.2.3.1 --- Anticipated barriers --- p.200 / Chapter 5.7.2.3.2 --- Solutions to the barriers --- p.201 / Chapter 5.8 --- Summary --- p.201 / Chapter CHAPTER 6 --- DISCUSSION OF THE PILOT STUDY / Chapter 6.1 --- Introduction --- p.205 / Chapter 6.2 --- Baseline characteristics of the participants --- p.205 / Chapter 6.2.1 --- Demographic and clinical characteristics --- p.206 / Chapter 6.2.2 --- Baseline outcome variables --- p.208 / Chapter 6.3 --- Effectiveness of the PEI program --- p.211 / Chapter 6.3.1 --- Quality of life --- p.211 / Chapter 6.3.2 --- Uncertainty --- p.214 / Chapter 6.3.3 --- Social support --- p.216 / Chapter 6.3.4 --- Anxiety and depression --- p.218 / Chapter 6.3.5 --- Sexual functioning --- p.221 / Chapter 6.4 --- Feasibility of implementing the PEI program in Hong Kong --- p.223 / Chapter 6.4.1 --- Intervention recipients’ perspective --- p.223 / Chapter 6.4.2 --- Health-care providers’ perspective --- p.226 / Chapter 6.5 --- Limitations of the pilot study --- p.229 / Chapter 6.5.1 --- Four types of validity threats --- p.229 / Chapter 6.5.2 --- Limitations in attention placebo, intervention format and integrity --- p.232 / Chapter 6.6 --- Summary --- p.234 / Chapter CHAPTER 7 --- CONCLUSION / Chapter 7.1 --- Introduction --- p.235 / Chapter 7.2 --- Implications for nursing practice --- p.235 / Chapter 7.3 --- Implications for future research --- p.236 / Chapter 7.4 --- Conclusion --- p.239 / REFERENCES --- p.241 / APPENDICES --- p.267
| Identifer | oai:union.ndltd.org:cuhk.edu.hk/oai:cuhk-dr:cuhk_328723 |
| Date | January 2013 |
| Contributors | Chow, Ka Ming., Chinese University of Hong Kong Graduate School. Division of Nursing. |
| Source Sets | The Chinese University of Hong Kong |
| Language | English, Chinese, Chinese |
| Detected Language | English |
| Type | Text, bibliography |
| Format | electronic resource, electronic resource, remote, 1 online resource (18, 274 leaves) : ill. (some col.) |
| Rights | Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/) |
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