Effects of psychoeducational interventions on sexual functioning, quality of life and psychological outcomes in patients with gynaecological cancer: A systematic review.

Abstract

The diagnosis of gynaecological cancer and the effects of related treatment have adverse effects on sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions are recommended for use in clinical areas for gynaecological cancer patients to improve patient outcomes. However, the evidence for its effectiveness is far from conclusive. Moreover, such interventions are still scarce or even absent in most countries. To identify the best available evidence related to the effectiveness of psychoeducational interventions for gynaecological cancer patients on sexual functioning, quality of life and psychological outcomes. Randomized controlled trials.Adult women who with a primary gynaecological cancer confirmed by pathology test.Psychoeducational interventions that aimed at enhancing the acceptance of the disease and recovery from the illness and treatment among gynaecological cancer patients.Sexual functioning, quality of life and psychological outcomes including, but not limited to, anxiety, depression, distress, adjustment to illness, mood, self-esteem, uncertainty, and coping. Thirty electronic bibliographic databases in English and Chinese were searched from their inception to April 2012. The Joanna Briggs Institute Critical Appraisal Checklist for experimental studies was used to critically appraise the methodological quality of studies. Two reviewers extracted and summarized the details of included studies using the Joanna Briggs Institute data extraction form independently. Quantitative results of comparable studies were pooled in statistical meta-analysis. Standardized mean difference and 95% confidence interval were calculated for the summary effect of continuous data measured by different scales. Results were presented in narrative form where statistical pooling was not appropriate. A total of 11 randomized controlled trials involving 975 gynaecological cancer patients were included. Only four studies were comparable to perform meta-analysis. On the basis of two studies examining the outcome of depression, there was a significant improvement in depressive symptoms (SMD: -0.80; 95% CI: -1.05 to -0.54) among participants in the intervention group in which information provision, cognitive-behavioral therapy and counseling were combined together. On the basis of another two studies examining the outcome of quality of life, there was no significant benefit in physical aspect of quality of life (SMD: -0.12; 95% CI: -0.45 to 0.20; p = 0.46) for the intervention group. Conversely, the control group of information-only therapy demonstrated significant effects on mental aspect of quality of life (SMD: -0.41; 95% CI: -0.74 to -0.08; p = 0.01) compared to those receiving psychoeducational interventions. There were no conclusive findings regarding the effects of psychoeducational interventions on the outcomes of sexual functioning, anxiety, distress, adjustment to illness, mood, self-esteem, uncertainty and coping among the gynaecological cancer patients. The review demonstrated evidence of positive effects of psychoeducational interventions on gynaecological cancer patients.The review suggested that psychoeducational interventions incorporate all four components, i.e. information provision, cognitive-behavioral therapy, social support and counseling. The format could be individual or group, with or without couple participation. A nurse was preferred to be the ideal provider. Provision time frame should be before the start of the treatment and continued after discharge, and the number of sessions could be four. Each session should be between 30 minutes to one hour long.More well-designed randomized controlled trials are needed to further examine the effects of psychoeducational interventions on psychological outcomes in this group of patients. Due to the diversity of these interventions, the optimal format of each also requires investigation.