Meta Analysis Of Psychological Intervention On Emotional Distress And Quality Of Life Of Patients With Malignant Tumor

ObjectiveTo identify and systematically examine the clinical effectiveness of psychological intervention for patients with malignant tumor compared with standard care.MethodsA systematic search of the major electronic databases Cochrane, Embase, Ovid, CINAHL, Pub Med, Web of Science, CNKI, CBM disc, VIP, Sino Med, WanFang between January 1980-December 2014 was conducted with exactly designed search strategies. The literatures of randomized controlled trials (RCT) on the effectiveness of psychological intervention were selected and measures of Quality of Life (QOL), emotional distress (anxiety and depression) were extracted from the randomized controlled trials. All the included studies were selected according to the strict inclusion criteria and exclusion criteria and the credibility of the outcome of each study was evaluated using the Cochrane Handbook. Review Manager 5.0 software was applied in this review.ResultsWe identified 41 RCTs(12 Chinese articles and 29 English articles), psychological intervention showed a significant effect on the improvement on QOL of patients (MD=5.31,95% CI (2.99,7.63), Z=4.49, P<0.00001), reduction on levels of anxiety(MD=-10.75,95% CI (-15.59,-5.90), Z=4.35, P<0.0001) and depression(MD=-9.85,95% CI (-11.35,-8.35), Z=12.86, P<0.00001),and decrease on the level of emotional distress(MD=-20.13, 95% CI (-25.35,-14.91), Z=7.75, P<0.00001)compared with conventional standard care. In addition, long term psychological intervention had a better effect on the improvement on QOL of patients than short term one (short term:MD=-0.63,95CI (-3.72,2.47), Z=0.40, P=0.69; long term: MD=7.93,95CI (3.75,12.12), Z=3.71, P=0.0002) while the short term psychological intervention showed a better effect on reduction on the levels of anxiety(short term:MD=-13.98,95%CI (-23.73,-4.23), Z=2.81, P=0.005; long term:MD=-6.01,95CI%(-9.07,-2.95), Z=3.85, P=0.0001), depression (short term:MD=-13.10,95%CI(-16.99,-9.22),Z=6.61,P<0.00001; long term:MD=-7.86,95CI%(-9.30,-6.42), Z=10.72,P<0.00001)and emotional distress (short term:MD=-13.98,95%CI (-23.73,-4.23), Z=2.81, P=0.005; long term:MD=-6.01,95CI%(-9.07,-2.95), Z=3.85, P=0.0001) than the long term one. What’s more, psychological intervention conducted in inpatient had a better effect on the improvement on QOL(inpatient:MD=8.78,95CI% (4.74,12.82), Z=4.26, P<0.001; outpatient:MD=3.11,95CI%(0.62,5.60), Z=2.45, P=0.01) and emotional distress (inpatient:MD=-22.09,95CI%(-26.99,-17.2), Z=2.36, P=0.02; outpatient:MD=-16.23,95CI%(-29.70,2.76), Z=2.36, P=0.02) of patients than one conducted in outpatient. At last, we found that group psychological intervention achieved a better effect on the increase of QOL (group:MD=8.41,95CI%(6.62,10.20), Z=9.21, P<0.0000; individual:MD=4.64,95CI%(2.03,7.25), Z=3.48, P=0.0005) than the individual ones while the individual psychological intervention showed a better effect on the decrease of emotional distress(group:MD=-16.32, 95CI%(-18.77,-4.81), Z=3.31, P<0.00001; individual:MD=-23.62,95CI% (-29.59,-17.64), Z=7.75, P<0.0001) than the group psychological intervention.ConclusionPsychological intervention could promote the improvement of QOL and decrease of emotional distress among patients with malignant tumor compared with standard care. Based on the evidence of this article, we recommended the patients take short term psychological intervention conducted in inpatient and continue to take the long term psychological intervention conducted in outpatient. Considering methodological limitations of included studies,the conclusion of this study should be interpreted with cautions and be validated in more RCT in the future.