A systematic mixed studies review of health behaviour change interventions in colorectal cancer survivors

eHealth interventions to support colorectal cancer patients' self-management after discharge from surgery-an integrative literature review

INTRODUCTION

Colorectal cancer (CRC) creates elevated self-management demands and unmet support needs post-discharge. Follow-up care through eHealth post-primary surgery may be an effective means of supporting patients' needs. This integrative review describes the evidence regarding eHealth interventions post-hospital discharge focusing on delivery mode, user-interface and content, patient intervention adherence, impact on patient-reported outcomes and experiences of eHealth.

METHODS

A university librarian performed literature searches in 2021 using four databases. After screening 1149 records, the authors read 30 full-text papers and included and extracted data from 26 papers. Two authors analysed the extracted data using the 'framework synthesis approach'.

RESULTS

The 26 papers were published between 2012 and 2022. The eHealth interventions were mainly delivered by telephone with the assistance of healthcare professionals, combined with text messages or video conferencing. The user interfaces included websites, applications and physical activity (PA) trackers. The interventions comprised the monitoring of symptoms or health behaviours, patient information, education and counselling. Evidence showed a better psychological state and improved PA. Patients reported high satisfaction with eHealth. However, patient adherence was inadequately reported.

CONCLUSIONS

eHealth interventions may positively impact CRC patients' anxiety and PA regardless of the user interface. Patients prefer technology combined with a human element.

Effects of behavioral change techniques on diet and physical activity in colorectal cancer patients: a systematic review and meta-analysis

PURPOSE

To investigate the effect of behavior change technology on diet, exercise, and sedentary behaviors in colorectal cancer over the last decade.

METHODS

This study systematically searched six English databases (Cochrane Library, EMBASE, APA PsycInfo, SCOPUS, PubMed, Web of Science) and three Chinese databases (CNKI, WanFang, and SINOMEd), searched for eligible clinical trials published between January 1, 2012, and December 31, 2021. Each database follows the principle of PICOS and adopts the method of subject words combined with free words to conduct literature retrieval, such as "colorectal cancer" and "behavior change intervention." Meta-analysis was performed using RevMan 5.3 software. Continuous data using the same measurement tools were analyzed using weighted mean difference (MD). Otherwise, standard mean difference (SMD) was used for analysis. The confidence interval is 95%. There was no significant statistical heterogeneity between the studies (P > 0.1, I² < 50%), and fixed-effects model was used. There was statistical heterogeneity (P ≤ 0.1), I² ≥ 50%), and the random effects model was used for analysis. The Cochrane risk of bias tool was used to assess the risk of bias in the included studies.

RESULTS

In total, 15 good-quality randomized controlled trials were identified. Six studies focused on eating habits. Twelve studies focused on physical activity. We found that behavior change techniques had significant effects on colorectal cancer survivors' eating behaviors such as frequency of fruit and vegetable intake and mastery of dietary knowledge (P < 0.05). The meta-analysis showed that the amount of physical activity in the intervention group increased by 71.76 min/w (16.27 to 127.24, P = 0.01) at 3 months after treatment compared with the control group. The meta-analysis showed that the amount of physical activity in the intervention group increased by 113.97 min/w (48.34 to 179.59, P < 0.001) at 6 months after treatment compared with the control group. The results revealed significant difference in the overall effect of the behavior change technique on the amount of exercise. Behavior change techniques were not found to have significant effects on body weight and BMI in colorectal cancer survivors, but it had a significant effect on sedentary behavior (P < 0.05).

CONCLUSIONS

The effects of behavioral change technique intervention on diet and physical activity may be more clinically significant at 6 months. This is the first systematic review and meta-analysis to summarize the effectiveness of a behavioral change techniques health behavior intervention in patients with colorectal cancer.

Application of the hospital-family holistic care model in caregivers of patients with permanent enterostomy: A randomized controlled trial

AIMS

To evaluate the effectiveness of the hospital-family holistic care model based on the theory of 'Timing It Right' in caregivers of patients with permanent enterostomy.

DESIGN

A prospective randomized controlled trial.

METHODS

One hundred and twenty-five caregivers of patients with permanent enterostomy were recruited from 1 May 2017-31 August 2019. They were randomized into either intervention group (N = 62) or control group (N = 63). The control group received routine care and follow-up, while the intervention group received routine care, follow-up, and hospital-family holistic care intervention based on 'Timing It Right'. The care ability, psychological distress, and life quality of the caregivers were evaluated between the groups before the intervention, at discharge, and 3 and 6 months after discharge.

RESULTS

One hundred and eleven caregivers completed the study (88.8%). At 3 and 6 months after discharge, the care ability and life quality in the intervention group were significantly better than those in the control group (t = 8.506/9.783, t = 22.652/26.179, p < 0.05) based on the t tests, and the psychological distress was lower than that in the control group. The ostomy adaptability of the control group was significantly lower than that in the intervention group (p < 0.001) based on the t tests, and the χ² test showed that ostomy complication was more than that in the intervention group (23.81% vs. 12.90% and 34.92% vs. 19.35%; p < 0.05) at 3 and 6 months after discharge. The interaction between time and group showed that the effect of time factor varied with the group and the four evaluation indexes in the intervention group gradually improved with the extension of the observation time and were better than those in the control group based on generalized estimating equation model.

CONCLUSION

The hospital-family holistic care model based on 'Timing It Right' can effectively improve the care ability of caregivers of patients with permanent enterostomy, reduce psychological distress, and improve the quality of life.

IMPACT

The caregivers of patients with permanent enterostomy showed dynamic changes in their care experience and needs at different stages of the disease. The hospital-family holistic care intervention strategy based on 'Timing It Right' can effectively improve the caregiver's care ability, alleviate psychological distress, and improve the quality of life. Additionally, improving the patients' stoma adaptability and reducing the incidence of complications related to ostomy.