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系統識別號 U0026-1302201816142200
論文名稱(中文) 罹癌夫妻介入方案與對偶調適之統合分析:成效與調節變項探討
論文名稱(英文) A comprehensive meta-analysis of couple-based interventions on dyadic adjustment in coping with cancer: effectiveness and moderating variables
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 106
學期 1
出版年 107
研究生(中文) 劉育真
研究生(英文) Yu-Chen Liu
學號 T26024053
學位類別 碩士
語文別 英文
論文頁數 118頁
口試委員 指導教授-林梅鳳
召集委員-林聖翔
口試委員-方素瓔
中文關鍵字 罹癌夫妻  夫妻介入方案  對偶調適  統合分析  調節效果 
英文關鍵字 couples with cancer  couple-based intervention  dyadic adjustment  meta-analysis  moderating effects 
學科別分類
中文摘要 背景
癌症可被視為影響癌症病人與其伴侶的「我們的疾病(we disease)」。對偶因應可能影響夫妻間的心理困擾,而以夫妻介入方案可能對關係功能具有潛在效益,然而,其介入方式、效果、效量關係仍未有一致性的結果。此外,夫妻介入方案的成效是否隨角色和性別特定的參與者而不同亦仍不清楚。
目的
檢視增進對偶調適的夫妻介入方案(couple-based interventions on improving dyadic adjustment,CIIDA)相較於對照組(常規照護或替代方案)在不同角色的罹癌夫妻其對偶調適與心理調適的立即效果、確立CIIDA在特定角色與性別的效果、與檢視CIIDA在對偶調適的持續效果和其調節因子。
方法
檢索策略於六個資料庫進行,納入分析之研究的參考文獻列表亦會進行檢視,並聯絡相關作者以確立是否有其他相關文獻。納入條件、偏誤風險、和資料提取皆由兩位審核者單獨進行評讀,研究結果將以g效果值與95%信賴區間呈現,並檢視其合併效果的異質性,離群值將會進一步移除和以極值調整(Winsorization)等方法檢視,整體證據品質將以GRADE法進行評估。此外,研究方法、參與對象、介入因子等對整體效果值的影響性將以次群組分析進行檢視。
結果
本統合分析僅納入所有研究對象為夫婦或為戀愛關係對偶之研究結果,共28篇研究呈現CIIDA成效的研究,其介入時間範圍為1至6個月,分別介入3至16次,研究參與者(n = 4813)以為中年為主(平均55歲)。統合分析結果顯示CIIDA在病人對偶調適的改善上具有小至中度的效果值,並於介入後12個月期間有下降的趨勢(g = 0.21–0.17),而在伴侶中無顯著效果。
在特定角色與性別的效果上,發現女性病人為CIIDA的最大受益參與者,結果顯示CIIDA(介入4–6次)對其對偶調適(g = 0.31)和憂鬱(g = 0.32)的具有小至中的改善成效。然而,此些成效並未在男性病人或不同性別的伴侶上達到顯著。
在對偶調適的立即效果上,女性特定癌症、情感表露技巧、和心理師提供介入等為CIIDA在病人方面的中介因子;夫妻共同參與、回家作業的指派、和8週以上的介入時間為CIIDA在伴侶方面的中介因子。然而,在不同的對照情境、偏誤風險、癌症期別、介入方式、介入次數、單次介入的時間、和總介入劑量等變項上未有顯著的中介效果。
在心理調適上,CIIDA在改善病人的憂鬱(g = 0.27)和心理健康(g = 0.28)有立即成效,而在伴侶方面僅有憂鬱(g = 0.29)達到顯著改善。
結論
本研究為首篇探討CIIDA對特定角色與性別的癌症夫妻其對偶調適效果的隨機對照試驗統合分析,發現CIIDA的介入設計多以病人為中心,而女性病人較男性病人其伴侶關係較短、年紀較輕,可能使得女性病人為CIIDA介入下最受益的參與者。為近一步增進CIIDA對病人的效果,建議可以加入情感表露技巧的介入元素並由心理師領導,以增加正向的對偶溝通。此外,為使CIIDA有效達到對伴侶的需求,建議未來的CIIDA介入設計應考量由夫妻共同參加、指派回家作業、與長達8週的介入時程。
英文摘要 Background
Cancer can be seem as “we disease” that impacts cancer patients and their spousal partners. Dyadic coping may influence the distress between couples and the potential beneficial effects of couple-based intervention on their relationship functioning has been identified. However, the approach, effectiveness, and dose-response relationship of interventions were inconsistent. Moreover, whether the effects of couple-based interventions were different among role- and gender- specific participants were still unknown.
Objectives
To evaluate the immediate effects of couple-based interventions on improving dyadic adjustment (CIIDA) compared to controlled status (usual care or alternative programmes) on dyadic adjustment and psychological adjustment outcomes in different roles among couples with cancer. The role- and gender-specific effects of CIIDA were further identified. The sustaining effects and moderators of CIIDA on dyadic adjustment were further examined.
Methods
The searches were performed in six databases. The reference lists of included studies and selected reviews, and contacted authors of relevant studies were examined also. All the trials for inclusion, risk of bias and extracted data were assessed by two reviewers independently. The study results which judged to be clinically homogeneous in different comparisons were pooled by reporting g-value with 95% confidence intervals (CIs). Outliers were further examined by removed and Winsorized. The overall quality of the evidence for each comparison were assessed by using the GRADE approach. Subgroup analysis were conducted to further examine the influence of the study method, participant, and intervention factors on effect sizes.
Results
Only studies reporting all the couples were married or in a romantic relationship were included. There were 28 studies with the effects of CIIDA with a range of 3 to 16 sessions 1 to 6 months duration were investigated. Study participants (n = 4813) were primary middle aged (mean = 55.0 years old). CIIDA had small to moderate effects on dyadic adjustment with a decreasing trends among 12 months post-treatment period (g = 0.21 to 0.17) for patients but spousal partners.
For role- and gender-specific effects, female patients were the most beneficial participants from CIIDA with 4 to 6 sessions immediate on both dyadic adjustment (g = 0.31) and depression (g = 0.32). Whereas, no significant effects in male patients and any gender of spousal partners.
In terms of immediate effect on dyadic adjustment, female-specific cancer, emotional expression skill, and psychologist provider were the moderators for patients; couple attend together, homework assignment, and longer than 8 weeks were the beneficial subgroups for spousal partners. Whereas, control condition, risk of bias, stage, approach, mode of delivery, number of sessions, length of each session, and total dose had no significant moderating effects.
For psychological adjustment, CIIDA had immediate effects on depression (g = 0.27) and psychological well-being (g = 0.28) for patients, but depression effect (g = 0.29) for spousal partners only.
Conclusions
This is the first RCTs meta-analysis to identify the effectiveness of CIIDA on dyadic adjustment with gender- and role-specific participants among couples with cancer. Female patients may be the mostly beneficial participants of CIIDA with lesser length of relationship, younger age than male patients, and the patient-focused intervention. To further improving the effectiveness of CIIDA for patients, adopting emotional expression skill and leading by psychologists, which may increase the positive dyadic communication, will be suggested. Moreover, to successfully reach the needs of spousal partners among CIIDA, participating by couple together with a homework assignment for over 8 weeks should be considered for future CIIDA design.
論文目次 中文摘要 I
ABSTRACT III
ACKNOWLEDGEMENTS V
TABLE OF CONTENTS VII
LIST OF TABLES IX
LIST OF FIGURES X
LIST OF APPENDICES XII
CHAPTER 1. INTRODUCTION 1
1.1 Background 1
1.2 Objectives 7
1.3 Study framework 8
1.4 Research questions 8
1.5 Hypotheses 9
CHAPTER 2. METHODS 10
2.1 Criteria for considering studies for this review 10
2.2 Search methods for identification of studies 12
2.3 Data collection and analysis 12
2.4 Data synthesis 17
CHAPTER 3. RESULTS 20
3.1 Description of studies 20
3.2 Included studies 23
3.3 Effects of interventions 31
3.3.1 Primary outcome – dyadic adjustment 31
3.3.2 Secondary outcome – psychological adjustment 35
3.3.3 Sustaining effect 39
3.3.4 Subgroup analysis 39
3.3.5 Meta-regression 44
CHAPTER 4. DISCUSSION 45
4.1 Immediate and sustaining effects of CIIDA on dyadic adjustment 45
4.2 Immediate effects of CIIDA on psychological adjustment 46
4.3 Immediate effects in gender- and role-specific subsample 46
4.4 Moderators of immediate CIIDA promoting dyadic adjustment in patients 47
4.5 Moderators of immediate CIIDA promoting dyadic adjustment in spousal partners 48
4.6 Limitations 50
CHAPTER 5. CONCLUSIONS AND APPLICATION 51
5.1 Conclusions 51
5.2 Applications 51
5.3 Suggestions 52
REFERENCES 53
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