Effective integration of family-focused nurse interventions in critical care is crucial for improving quality of family care, reducing family distress, and mitigating adverse long-term health outcomes. However, knowledge on how to effectively integrate these interventions in dynamic settings, such as intensive care units, remains underexplored. This study addresses this knowledge gap by examining the implementation of a nurse-led, multi-component family support intervention, which was introduced using a tailored implementation strategy as part of the Family in Intensive Care UnitS (FICUS®) cluster-randomized trial. It aims to evaluate the integration from health professionals' perspective and to understand how implementation outcomes are associated with the intervention's integration and clinical benefit.
Methods
A Normalization Process Theory-guided, multi-center, mixed-methods study was conducted in eight Swiss adult intensive care units. All health professionals (n = 518) were invited at the end of the active 18-month implementation period (September 2023 to April 2024) to complete an online survey, which included the German version of the Normalization MeAsure Development questionnaire and measures of the family support interventions' acceptability, appropriateness, feasibility, benefit, and sustainability. Eight focus group interviews (6–11 health professionals each) were conducted. Ten regression models were performed using mixed linear effects and logistic models to determine associations between implementation outcomes (acceptance, appropriateness, feasibility), integration (normalization, sustainability) and benefit for families, patients, team collaboration and individual work. Qualitative content analysis was used to identify themes regarding health professionals' perceptions of implementation.
Findings
A total of 228 participants (44 %) completed the survey, 64 were interviewed. The level of intervention normalization was high and associated with its acceptability, appropriateness, feasibility and perceived benefit for families and health professionals (p < 0.05). While feasibility predicted integration, conceptualized as normalization and perceived sustainability (p < 0.001), the benefit for teams and families was predicted by the family support intervention's acceptability and appropriateness (p < 0.05). Key facilitators for integration were clear roles, structured workflows, and team engagement. Overall, the family support intervention was valued for supporting families and strengthening team collaboration.
Conclusion
Study findings demonstrate that the nurse-led family support intervention is acceptable, appropriate, feasible and beneficial from the perspective of health professionals. Further research is needed on how to best scale and integrate this intervention across an entire health system.
{"title":"Integrating a family support intervention in intensive care units: A mixed-methods summative evaluation with health professionals","authors":"Saskia Oesch , Lotte Verweij , Marco Riguzzi , Tracy Finch , Lauren Clack , Rahel Naef","doi":"10.1016/j.ijnurstu.2025.105308","DOIUrl":"10.1016/j.ijnurstu.2025.105308","url":null,"abstract":"<div><h3>Background</h3><div>Effective integration of family-focused nurse interventions in critical care is crucial for improving quality of family care, reducing family distress, and mitigating adverse long-term health outcomes. However, knowledge on how to effectively integrate these interventions in dynamic settings, such as intensive care units, remains underexplored. This study addresses this knowledge gap by examining the implementation of a nurse-led, multi-component family support intervention, which was introduced using a tailored implementation strategy as part of the Family in Intensive Care UnitS (FICUS®) cluster-randomized trial. It aims to evaluate the integration from health professionals' perspective and to understand how implementation outcomes are associated with the intervention's integration and clinical benefit.</div></div><div><h3>Methods</h3><div>A Normalization Process Theory-guided, multi-center, mixed-methods study was conducted in eight Swiss adult intensive care units. All health professionals (n = 518) were invited at the end of the active 18-month implementation period (September 2023 to April 2024) to complete an online survey, which included the German version of the Normalization MeAsure Development questionnaire and measures of the family support interventions' acceptability, appropriateness, feasibility, benefit, and sustainability. Eight focus group interviews (6–11 health professionals each) were conducted. Ten regression models were performed using mixed linear effects and logistic models to determine associations between implementation outcomes (acceptance, appropriateness, feasibility), integration (normalization, sustainability) and benefit for families, patients, team collaboration and individual work. Qualitative content analysis was used to identify themes regarding health professionals' perceptions of implementation.</div></div><div><h3>Findings</h3><div>A total of 228 participants (44 %) completed the survey, 64 were interviewed. The level of intervention normalization was high and associated with its acceptability, appropriateness, feasibility and perceived benefit for families and health professionals (p < 0.05). While feasibility predicted integration, conceptualized as normalization and perceived sustainability (p < 0.001), the benefit for teams and families was predicted by the family support intervention's acceptability and appropriateness (p < 0.05). Key facilitators for integration were clear roles, structured workflows, and team engagement. Overall, the family support intervention was valued for supporting families and strengthening team collaboration.</div></div><div><h3>Conclusion</h3><div>Study findings demonstrate that the nurse-led family support intervention is acceptable, appropriate, feasible and beneficial from the perspective of health professionals. Further research is needed on how to best scale and integrate this intervention across an entire health system.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105308"},"PeriodicalIF":7.1,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Advanced cancer impacts physical, emotional, social, and spiritual well-being of a person's life. While palliative care is known to alleviate suffering for patients and families, its availability remains limited, especially in resource-constrained settings. Nurses play a vital role in healthcare, with their leadership and interventions significantly impacting patient outcomes; however, synthesised evidence on nurse-led palliative care for patients with advanced cancer is limited.</div></div><div><h3>Aim</h3><div>To evaluate the available evidence on the clinical effectiveness of nurse-led palliative care interventions for patients with advanced cancer.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>Six international databases, including MEDLINE, CINAHL, Cochrane Library, Embase, PsycINFO, and ProQuest Dissertations, were systematically searched from inception to May 2025. Randomised controlled trials and quasi-experimental studies were included. Studies were eligible if the interventions fell within the scope of palliative care and led by nurses, regardless of the use of palliative care terminology or care setting. Data were extracted, and Hedges' <em>g</em> was calculated as the effect estimate for meta-analysis. Studies with insufficient data were synthesised narratively. Sensitivity and post hoc subgroup analyses were also performed. Methodological quality was assessed using the revised JBI checklists for risk of bias assessment in randomised controlled trials and quasi-experimental studies.</div></div><div><h3>Results</h3><div>A total of 51 studies (n = 6152) were included in this review, with 35 studies (n = 4623) included in the meta-analysis. Most studies originated from high-income countries (n = 43). Notable improvements were observed in the nurse-led palliative care group compared to the control group, including quality of life (Hedges' <em>g</em> = 0.26, 95 % CI: 0.04 to 0.49), total pain score (Hedges' <em>g</em> = −<!--> <!-->0.53, 95 % CI: −<!--> <!-->0.71 to −<!--> <!-->0.35), symptom burden (Hedges' <em>g</em> = −<!--> <!-->0.14, 95 % CI: −<!--> <!-->0.28 to 0.00), fatigue (Hedges' <em>g</em> = −<!--> <!-->0.23, 95 % CI: −<!--> <!-->0.43 to −<!--> <!-->0.06), functional capacity (Hedges' <em>g</em> = 0.25, 95 % CI: 0.07 to 0.43), and well-being (Hedges' <em>g</em> = 0.50, 95 % CI: 0.01 to 1.00, from correlation coefficient of 0.9 for a pre-posttest study). Nurse-led palliative care interventions varied, covering symptom monitoring, follow-up, education, patient consultation, pain management, and multidisciplinary coordination.</div></div><div><h3>Conclusion</h3><div>Nurse-led palliative care has a potential effect to improve quality of life, total pain score, symptom burden, fatigue, functional capacity, and well-being for patients with advanced cancer. Future research is needed to evaluate the effectiveness of nurse-led palliative care,
{"title":"Clinical effectiveness of nurse-led palliative care interventions for patients with advanced cancer: A systematic review and meta-analysis","authors":"Prapan Phetlerthirunkul , Vicki Tsianakas , Salma Ayis , Ruth Harris","doi":"10.1016/j.ijnurstu.2025.105303","DOIUrl":"10.1016/j.ijnurstu.2025.105303","url":null,"abstract":"<div><h3>Background</h3><div>Advanced cancer impacts physical, emotional, social, and spiritual well-being of a person's life. While palliative care is known to alleviate suffering for patients and families, its availability remains limited, especially in resource-constrained settings. Nurses play a vital role in healthcare, with their leadership and interventions significantly impacting patient outcomes; however, synthesised evidence on nurse-led palliative care for patients with advanced cancer is limited.</div></div><div><h3>Aim</h3><div>To evaluate the available evidence on the clinical effectiveness of nurse-led palliative care interventions for patients with advanced cancer.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>Six international databases, including MEDLINE, CINAHL, Cochrane Library, Embase, PsycINFO, and ProQuest Dissertations, were systematically searched from inception to May 2025. Randomised controlled trials and quasi-experimental studies were included. Studies were eligible if the interventions fell within the scope of palliative care and led by nurses, regardless of the use of palliative care terminology or care setting. Data were extracted, and Hedges' <em>g</em> was calculated as the effect estimate for meta-analysis. Studies with insufficient data were synthesised narratively. Sensitivity and post hoc subgroup analyses were also performed. Methodological quality was assessed using the revised JBI checklists for risk of bias assessment in randomised controlled trials and quasi-experimental studies.</div></div><div><h3>Results</h3><div>A total of 51 studies (n = 6152) were included in this review, with 35 studies (n = 4623) included in the meta-analysis. Most studies originated from high-income countries (n = 43). Notable improvements were observed in the nurse-led palliative care group compared to the control group, including quality of life (Hedges' <em>g</em> = 0.26, 95 % CI: 0.04 to 0.49), total pain score (Hedges' <em>g</em> = −<!--> <!-->0.53, 95 % CI: −<!--> <!-->0.71 to −<!--> <!-->0.35), symptom burden (Hedges' <em>g</em> = −<!--> <!-->0.14, 95 % CI: −<!--> <!-->0.28 to 0.00), fatigue (Hedges' <em>g</em> = −<!--> <!-->0.23, 95 % CI: −<!--> <!-->0.43 to −<!--> <!-->0.06), functional capacity (Hedges' <em>g</em> = 0.25, 95 % CI: 0.07 to 0.43), and well-being (Hedges' <em>g</em> = 0.50, 95 % CI: 0.01 to 1.00, from correlation coefficient of 0.9 for a pre-posttest study). Nurse-led palliative care interventions varied, covering symptom monitoring, follow-up, education, patient consultation, pain management, and multidisciplinary coordination.</div></div><div><h3>Conclusion</h3><div>Nurse-led palliative care has a potential effect to improve quality of life, total pain score, symptom burden, fatigue, functional capacity, and well-being for patients with advanced cancer. Future research is needed to evaluate the effectiveness of nurse-led palliative care, ","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105303"},"PeriodicalIF":7.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145592860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/j.ijnurstu.2025.105307
Rick Yiu Cho Kwan , Jing Jing Su , Janet Lok Chun Lee , Fowie Ng , Manfred Lai , Chen Lei , Sally Chan
Background
Older adults living with physical disabilities in residential care homes are at elevated risk for depression and loneliness, which negatively impacts their quality of life. Immersive virtual reality is an evolving modality that engages older adults in therapeutically oriented activities to address these mental health challenges.
Objectives
This study evaluated the effects of a nurse-led multi-disciplinary therapeutic immersive virtual reality programme, incorporating natural scenes, tourism, and reminiscence, on mental health outcomes.
Methods
This randomised controlled trial was conducted in multiple residential care homes. Eligible participants were older adults with physical disabilities. Participants were randomly assigned to either the intervention group, which received a 12-session immersive virtual reality therapeutic programme, or the control group, which continued with standard care. Outcomes were measured at baseline and 6 weeks immediately after the intervention, specifically assessing mental well-being, depression, loneliness, health-related quality of life, and perceived social support. Generalised Estimating Equations were used to examine the effects of time, group, and the interaction between time and group. The level of significance was set at 0.05.
Results
A total of 265 participants from 26 centres were recruited, with 133 and 132 participants randomly assigned to the intervention and control groups, respectively. In the immersive virtual reality therapeutic programme group, significant improvements were observed only within the group for mental well-being (p < .001), depressive symptoms (p < .001), and perceived social support (p = .002), whereas health-related quality of life improved significantly both within the group (p = .037) and compared to the control group (p = .025) after the intervention.
Conclusions
The immersive virtual reality intervention significantly improved the quality of life and mental health of older adults, although contamination may have diminished the differences between groups. This study suggests that the development of culturally adapted content for immersive virtual reality interventions, based on theoretical components, should be implemented in care to enhance the mental health of older adults. Further research is required to assess its long-term effects, implementation outcomes, cost-effectiveness, and component contributions.
{"title":"The effects of a therapeutic immersive virtual reality programme on the mental health of residential care home residents living with physical disabilities: A multi-centre randomised controlled trial","authors":"Rick Yiu Cho Kwan , Jing Jing Su , Janet Lok Chun Lee , Fowie Ng , Manfred Lai , Chen Lei , Sally Chan","doi":"10.1016/j.ijnurstu.2025.105307","DOIUrl":"10.1016/j.ijnurstu.2025.105307","url":null,"abstract":"<div><h3>Background</h3><div>Older adults living with physical disabilities in residential care homes are at elevated risk for depression and loneliness, which negatively impacts their quality of life. Immersive virtual reality is an evolving modality that engages older adults in therapeutically oriented activities to address these mental health challenges.</div></div><div><h3>Objectives</h3><div>This study evaluated the effects of a nurse-led multi-disciplinary therapeutic immersive virtual reality programme, incorporating natural scenes, tourism, and reminiscence, on mental health outcomes.</div></div><div><h3>Methods</h3><div>This randomised controlled trial was conducted in multiple residential care homes. Eligible participants were older adults with physical disabilities. Participants were randomly assigned to either the intervention group, which received a 12-session immersive virtual reality therapeutic programme, or the control group, which continued with standard care. Outcomes were measured at baseline and 6 weeks immediately after the intervention, specifically assessing mental well-being, depression, loneliness, health-related quality of life, and perceived social support. Generalised Estimating Equations were used to examine the effects of time, group, and the interaction between time and group. The level of significance was set at 0.05.</div></div><div><h3>Results</h3><div>A total of 265 participants from 26 centres were recruited, with 133 and 132 participants randomly assigned to the intervention and control groups, respectively. In the immersive virtual reality therapeutic programme group, significant improvements were observed only within the group for mental well-being (p < .001), depressive symptoms (p < .001), and perceived social support (p = .002), whereas health-related quality of life improved significantly both within the group (p = .037) and compared to the control group (p = .025) after the intervention.</div></div><div><h3>Conclusions</h3><div>The immersive virtual reality intervention significantly improved the quality of life and mental health of older adults, although contamination may have diminished the differences between groups. This study suggests that the development of culturally adapted content for immersive virtual reality interventions, based on theoretical components, should be implemented in care to enhance the mental health of older adults. Further research is required to assess its long-term effects, implementation outcomes, cost-effectiveness, and component contributions.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105307"},"PeriodicalIF":7.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.ijnurstu.2025.105304
Michaella Miller , Yasmeen Almomani , Pamela Hopwood , Paniz Haghighi , Abbey Davis , Emma Littler , Tamara J. Daly , Andrea D. Foebel , Ellen MacEachen
Background
Chronic underfunding of the long-term care sector, coupled with increased complexity of care, has deteriorated working conditions and contributed to severe staffing shortages of healthcare workers globally. While previous reviews have examined the association between long-term care staffing and care outcomes for residents, none have examined specifically how staffing structures affect the care-workers themselves.
Objective
The aim of this review is to investigate how staffing structures impact the quality of work-life, work-related outcomes of care-workers and the context that affects staffing decisions.
Methods
A narrative scoping review of primary empirical peer-reviewed literature was conducted to examine how long-term care staffing structures impact quality of work-life and work outcomes of care-workers in OECD countries. PubMed, CINAHL, and Scopus databases were searched for relevant articles published within the past 10 years. Searches yielded 4561 unique articles, which were independently screened by pairs of reviewers, of which 76 articles were included. Data were extracted and synthesized to examine the ways in which staffing structures impact the workforce, what structures existed, and how they came to be.
Results
Contextual factors shaped staffing decisions in long-term care, including both organizational/regulatory practices and external issues. These included market-based ideologies, increased care complexity, regulatory requirements, COVID-19, and organizational fiscal austerity, which affected the quality of work-life and work outcomes for care-workers. These factors contributed to chronic understaffing, restructuring of skill mix, and greater reliance on agency workers. Consequences for care-workers included work intensification, unpaid labour, and strained team dynamics, particularly where registered nurse oversight was limited. While some homes developed adaptive strategies to buffer these effects, inadequate staffing often eroded job quality, undermined teamwork, and contributed to job dissatisfaction, turnover, presenteeism, and adverse physical and psychological health outcomes.
Conclusions
This review shows that staffing structures have consequences for quality of work-life and work outcomes. A reliance on lean staffing eventually destabilizes the workforce, perpetuating recruitment and retention issues. This review suggests that to create and maintain a strong long-term care workforce, sufficient staffing with the right skills and competencies need to be a priority in improvement initiatives.
{"title":"The impact of staffing structures in long-term care homes on the quality of work-life and work outcomes of care-workers: A narrative scoping review","authors":"Michaella Miller , Yasmeen Almomani , Pamela Hopwood , Paniz Haghighi , Abbey Davis , Emma Littler , Tamara J. Daly , Andrea D. Foebel , Ellen MacEachen","doi":"10.1016/j.ijnurstu.2025.105304","DOIUrl":"10.1016/j.ijnurstu.2025.105304","url":null,"abstract":"<div><h3>Background</h3><div>Chronic underfunding of the long-term care sector, coupled with increased complexity of care, has deteriorated working conditions and contributed to severe staffing shortages of healthcare workers globally. While previous reviews have examined the association between long-term care staffing and care outcomes for residents, none have examined specifically how staffing structures affect the care-workers themselves.</div></div><div><h3>Objective</h3><div>The aim of this review is to investigate how staffing structures impact the quality of work-life, work-related outcomes of care-workers and the context that affects staffing decisions.</div></div><div><h3>Methods</h3><div>A narrative scoping review of primary empirical peer-reviewed literature was conducted to examine how long-term care staffing structures impact quality of work-life and work outcomes of care-workers in OECD countries. PubMed, CINAHL, and Scopus databases were searched for relevant articles published within the past 10 years. Searches yielded 4561 unique articles, which were independently screened by pairs of reviewers, of which 76 articles were included. Data were extracted and synthesized to examine the ways in which staffing structures impact the workforce, what structures existed, and how they came to be.</div></div><div><h3>Results</h3><div>Contextual factors shaped staffing decisions in long-term care, including both organizational/regulatory practices and external issues. These included market-based ideologies, increased care complexity, regulatory requirements, COVID-19, and organizational fiscal austerity, which affected the quality of work-life and work outcomes for care-workers. These factors contributed to chronic understaffing, restructuring of skill mix, and greater reliance on agency workers. Consequences for care-workers included work intensification, unpaid labour, and strained team dynamics, particularly where registered nurse oversight was limited. While some homes developed adaptive strategies to buffer these effects, inadequate staffing often eroded job quality, undermined teamwork, and contributed to job dissatisfaction, turnover, presenteeism, and adverse physical and psychological health outcomes.</div></div><div><h3>Conclusions</h3><div>This review shows that staffing structures have consequences for quality of work-life and work outcomes. A reliance on lean staffing eventually destabilizes the workforce, perpetuating recruitment and retention issues. This review suggests that to create and maintain a strong long-term care workforce, sufficient staffing with the right skills and competencies need to be a priority in improvement initiatives.</div></div><div><h3>Registration</h3><div>Not registered.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105304"},"PeriodicalIF":7.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145592862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.ijnurstu.2025.105305
Caitlin Deery , Grace Marconi , Kelly Ottosen , Kerry Hwang , Maneesh Prasad , Pauline Wong , Stephanie Garratt , Elizabeth Manias
<div><h3>Background</h3><div>Older adults are susceptible to medication harm during transitions of care, and families can help to mitigate this harm.</div></div><div><h3>Objectives</h3><div>This mixed methods systematic review aimed to investigate the ways family members are engaged in the medication management of older adults during transitions of care.</div></div><div><h3>Methods</h3><div>The search was conducted using six databases: CINAHL, MEDLINE, CENTRAL, PsycINFO, Embase, and International Pharmaceutical Abstracts. Qualitative, quantitative, and mixed methods studies were included. An English language and publication year (2018–present) limiter was applied. Hand searching of reference lists and forward searching was performed. Reports were included that focused on families of patients aged 65 years and older, involved medication management, and a transition of care. Thomas and Harden thematic analysis was conducted. Given the scarcity of quantitative data, meta-analysis was not possible, so a narrative summary was produced. Using convergent segregated synthesis, the narratively described quantitative data and the qualitative data underwent independent analysis, resulting in two sets of themes. The final step involved integration of both sets of themes. The Mixed Methods Appraisal Tool was used for quality assessment.</div></div><div><h3>Results</h3><div>20 reports were included, of which 17 were qualitative, 2 were mixed methods, and 1 was quantitative. Five analytical themes were constructed: 1) influence of family members' interpersonal experiences on involvement in medication management; (2) family members' perspectives on medication-related activities for safe transitions; (3) misalignment between family members, older adults, and the healthcare system; (4) interplay between information exchange and family engagement in medication decisions; and (5) family-centred approaches to improve medication management. One of these themes was derived only from qualitative data, due to no relevant quantitative data. The remaining four themes contained qualitative and quantitative data. Family involvement was adversely affected by alienation, caregiver burden, and older adults' reluctance to relinquish control. Information exchange was often poor, with one report finding that families were only involved in 17 % of encounters. Families stressed the importance of multidisciplinary coordination and structured communication, including written material. A discharge protocol reduced hospital readmission by 4 % and contributed to a 93 % medication adherence rate.</div></div><div><h3>Conclusions</h3><div>Family engagement was described positively by families who experienced collaborative information exchange. Contrastingly, negative interpersonal experiences and family misalignment with the healthcare system, such as when jargon was used, were hindrances to family engagement. Family inclusion during communication encounters and written material were identi
{"title":"Family engagement in the medication management of older adults during transitions of care: A mixed methods systematic review","authors":"Caitlin Deery , Grace Marconi , Kelly Ottosen , Kerry Hwang , Maneesh Prasad , Pauline Wong , Stephanie Garratt , Elizabeth Manias","doi":"10.1016/j.ijnurstu.2025.105305","DOIUrl":"10.1016/j.ijnurstu.2025.105305","url":null,"abstract":"<div><h3>Background</h3><div>Older adults are susceptible to medication harm during transitions of care, and families can help to mitigate this harm.</div></div><div><h3>Objectives</h3><div>This mixed methods systematic review aimed to investigate the ways family members are engaged in the medication management of older adults during transitions of care.</div></div><div><h3>Methods</h3><div>The search was conducted using six databases: CINAHL, MEDLINE, CENTRAL, PsycINFO, Embase, and International Pharmaceutical Abstracts. Qualitative, quantitative, and mixed methods studies were included. An English language and publication year (2018–present) limiter was applied. Hand searching of reference lists and forward searching was performed. Reports were included that focused on families of patients aged 65 years and older, involved medication management, and a transition of care. Thomas and Harden thematic analysis was conducted. Given the scarcity of quantitative data, meta-analysis was not possible, so a narrative summary was produced. Using convergent segregated synthesis, the narratively described quantitative data and the qualitative data underwent independent analysis, resulting in two sets of themes. The final step involved integration of both sets of themes. The Mixed Methods Appraisal Tool was used for quality assessment.</div></div><div><h3>Results</h3><div>20 reports were included, of which 17 were qualitative, 2 were mixed methods, and 1 was quantitative. Five analytical themes were constructed: 1) influence of family members' interpersonal experiences on involvement in medication management; (2) family members' perspectives on medication-related activities for safe transitions; (3) misalignment between family members, older adults, and the healthcare system; (4) interplay between information exchange and family engagement in medication decisions; and (5) family-centred approaches to improve medication management. One of these themes was derived only from qualitative data, due to no relevant quantitative data. The remaining four themes contained qualitative and quantitative data. Family involvement was adversely affected by alienation, caregiver burden, and older adults' reluctance to relinquish control. Information exchange was often poor, with one report finding that families were only involved in 17 % of encounters. Families stressed the importance of multidisciplinary coordination and structured communication, including written material. A discharge protocol reduced hospital readmission by 4 % and contributed to a 93 % medication adherence rate.</div></div><div><h3>Conclusions</h3><div>Family engagement was described positively by families who experienced collaborative information exchange. Contrastingly, negative interpersonal experiences and family misalignment with the healthcare system, such as when jargon was used, were hindrances to family engagement. Family inclusion during communication encounters and written material were identi","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105305"},"PeriodicalIF":7.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145592864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.ijnurstu.2025.105301
Zoe Samson , Laura M. Wagner , Lauren J. Hunt , Ulrike Muench
Background
The need for skilled in-home nursing care is growing, but the home health nursing workforce faces challenges with job turnover, fueling the concern that the supply of these nurses will be inadequate to meet demand.
Objective
To compare rates and predictors of turnover among registered nurses working in home health compared to hospital settings.
Study design
This was a secondary, cross-sectional analysis using data from the National Sample Survey of Registered Nurses (NSSRN) from survey years 2008, 2018, and 2022.
Population
Registered nurses in the US labor market (n = 3,381,768 in the 2008/2018 surveys; 1,625,288 from the 2022 survey).
Methods
Data for the 2008 and 2018 surveys were pooled and analyses were conducted separately with the 2022 data due to sample frame changes prohibiting pooled analyses. The primary outcome was job turnover and the independent variable was employment in either a hospital or home health setting. Covariates included sociodemographic, labor and workplace characteristics. We conducted descriptive statistics of sample characteristics and multivariate logistic regression models to estimate marginal effects of predictors on the probability of turnover from the hospital or home health setting. We then assessed interactions between setting and labor/workplace variables to assess predictors of turnover for home health versus hospital registered nurses.
Results
Overall, home health registered nurses reported longer career tenures and less advanced educational preparation than hospital nurses. Rates of turnover were comparable between home health and hospital registered nurses. Longer career tenure was generally protective against job turnover, but home health registered nurses were more likely than hospital registered nurses to turnover later in their career. Predicted probability of turnover at 11 to 20 years in nursing was 14.7 % for home health registered nurses (95 % CI 11.2, 18.2) versus 12.1 % for hospital registered nurses (95 % CI 10.9, 13.3). At 21 to 30 years, it was 16.3 % for home health registered nurses (95 % CI 12, 20.5) and 11 % for hospital registered nurses (95 % CI 9.6, 12.4). Interaction terms were also significant for work setting and weekly hours, demonstrating increased likelihood of turnover for home health registered nurses past the 40-h mark. There were no significant interactions identified in the 2022 data.
Conclusions
Our results suggest that attracting nurses earlier in their careers and schedule stabilization may be of particular importance for growth and retention efforts in the home health registered nurse workforce.
对熟练的家庭护理的需求正在增长，但家庭健康护理队伍面临着工作人员流动的挑战，加剧了对这些护士供应将不足以满足需求的担忧。目的比较家庭护理和医院护理注册护士的离职率和预测因素。研究设计这是一项二次横断面分析，使用了2008年、2018年和2022年全国注册护士抽样调查（NSSRN）的数据。人口美国劳动力市场的注册护士（2008/2018年调查n = 3,381,768； 2022年调查n = 1,625,288）。方法2008年和2018年的调查数据与2022年的数据进行汇总分析，因为样本框架的变化，不能进行汇总分析。主要结果是工作流动率，自变量是在医院或家庭保健机构的就业情况。协变量包括社会人口学、劳动力和工作场所特征。我们对样本特征进行了描述性统计，并建立了多变量logistic回归模型，以估计预测因子对医院或家庭健康机构离职概率的边际效应。然后，我们评估了环境和劳动力/工作场所变量之间的相互作用，以评估家庭保健与医院注册护士的离职预测因素。结果总体而言，家庭保健注册护士比医院护士的职业生涯更长，高等教育准备较少。家庭保健护士和医院注册护士的流动率相当。较长的职业任期通常对工作人员流动有保护作用，但家庭保健注册护士比医院注册护士更有可能在职业生涯后期发生人员流动。家庭保健注册护士11 - 20年护理工作的预测离职概率为14.7%(95%可信区间11.2,18.2)，而医院注册护士为12.1%（95%可信区间10.9,13.3）。在21至30岁时，家庭保健注册护士为16.3% (95% CI 12, 20.5)，医院注册护士为11% （95% CI 9.6, 12.4）。在工作设置和每周工作时间方面，相互作用条件也很重要，表明超过40小时大关的家庭健康注册护士的离职可能性增加。在2022年的数据中没有发现显著的相互作用。结论我们的研究结果表明，在职业生涯早期吸引护士和时间表稳定可能对家庭健康注册护士队伍的增长和保留工作特别重要。
{"title":"Predictors of job turnover among home health versus hospital nurses: An observational study using the National Sample Survey of Registered Nurses","authors":"Zoe Samson , Laura M. Wagner , Lauren J. Hunt , Ulrike Muench","doi":"10.1016/j.ijnurstu.2025.105301","DOIUrl":"10.1016/j.ijnurstu.2025.105301","url":null,"abstract":"<div><h3>Background</h3><div>The need for skilled in-home nursing care is growing, but the home health nursing workforce faces challenges with job turnover, fueling the concern that the supply of these nurses will be inadequate to meet demand.</div></div><div><h3>Objective</h3><div>To compare rates and predictors of turnover among registered nurses working in home health compared to hospital settings.</div></div><div><h3>Study design</h3><div>This was a secondary, cross-sectional analysis using data from the National Sample Survey of Registered Nurses (NSSRN) from survey years 2008, 2018, and 2022.</div></div><div><h3>Population</h3><div>Registered nurses in the US labor market (n = 3,381,768 in the 2008/2018 surveys; 1,625,288 from the 2022 survey).</div></div><div><h3>Methods</h3><div>Data for the 2008 and 2018 surveys were pooled and analyses were conducted separately with the 2022 data due to sample frame changes prohibiting pooled analyses. The primary outcome was job turnover and the independent variable was employment in either a hospital or home health setting. Covariates included sociodemographic, labor and workplace characteristics. We conducted descriptive statistics of sample characteristics and multivariate logistic regression models to estimate marginal effects of predictors on the probability of turnover from the hospital or home health setting. We then assessed interactions between setting and labor/workplace variables to assess predictors of turnover for home health versus hospital registered nurses.</div></div><div><h3>Results</h3><div>Overall, home health registered nurses reported longer career tenures and less advanced educational preparation than hospital nurses. Rates of turnover were comparable between home health and hospital registered nurses. Longer career tenure was generally protective against job turnover, but home health registered nurses were more likely than hospital registered nurses to turnover later in their career. Predicted probability of turnover at 11 to 20 years in nursing was 14.7 % for home health registered nurses (95 % CI 11.2, 18.2) versus 12.1 % for hospital registered nurses (95 % CI 10.9, 13.3). At 21 to 30 years, it was 16.3 % for home health registered nurses (95 % CI 12, 20.5) and 11 % for hospital registered nurses (95 % CI 9.6, 12.4). Interaction terms were also significant for work setting and weekly hours, demonstrating increased likelihood of turnover for home health registered nurses past the 40-h mark. There were no significant interactions identified in the 2022 data.</div></div><div><h3>Conclusions</h3><div>Our results suggest that attracting nurses earlier in their careers and schedule stabilization may be of particular importance for growth and retention efforts in the home health registered nurse workforce.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105301"},"PeriodicalIF":7.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145583873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Childhood functional constipation, a common concern within child healthcare, necessitates oral and rectal medical treatments, that are mostly administered by parents in the home environment. It is important to gather children’s perspectives in child- and family-centred care. The private nature of toileting, bowel movements, and faecal incontinence are areas of taboo and stigmatisation. Research is scarce on how children perceive this common but private situation of oral and rectal constipation treatment.
Objective
To explore children’s experiences of functional constipation and its treatments.
Design
A qualitative interview study with a constructionist epistemology and a predominantly experiential orientation.
Setting
Individual interviews were conducted in the child’s home, in the child’s familiar outpatient clinic, or on university premises. Open and permissive conversations about bowel habits, constipation, medical treatments, faecal leakage, and related feelings were digitally recorded and transcribed.
Participants
Twenty children (thirteen boys and seven girls) with functional constipation, aged 6–14 years, from four different outpatient clinics in southeast Sweden, who had experiences of oral and rectal medical treatments, were purposively recruited. Exclusion criteria were anorectal malformation or prior rectal surgery.
Methods
Transcripts were analysed using reflexive thematic analysis by Braun & Clarke.
Findings
This study provides a deeper understanding of why children choose not to go to the toilet. It explains how children perceive constipation treatment as simultaneously good and bad, and describes how faecal incontinence is strongly associated with the fear of exposure. The study also outlines the hopes and prospects of a cure. Four themes were created: 1) Procrastinating toilet visits – focus elsewhere, 2) Dreading exposure in a vulnerable position, 3) Enemas, a nightmare and a relief, 4) A doubtful hope during the treatment journey.
Conclusions
Care providers must acknowledge and validate the child’s perspective in constipation treatment situations. Our study provides an understanding of this perspective, which should be incorporated into clinical conversations with children about their diagnosis and proposed constipation treatment regimen. Adopting an approach that acknowledges children’s views based on this new information may enhance collaboration between care providers, parents, and children during constipation care.
{"title":"Children's experiences of functional constipation: A qualitative reflexive thematic analysis","authors":"Gunilla Flankegård , Patrik Rytterström , Berit M. Gustafsson , Evalotte Mörelius","doi":"10.1016/j.ijnurstu.2025.105302","DOIUrl":"10.1016/j.ijnurstu.2025.105302","url":null,"abstract":"<div><h3>Background</h3><div>Childhood functional constipation, a common concern within child healthcare, necessitates oral and rectal medical treatments, that are mostly administered by parents in the home environment. It is important to gather children’s perspectives in child- and family-centred care. The private nature of toileting, bowel movements, and faecal incontinence are areas of taboo and stigmatisation. Research is scarce on how children perceive this common but private situation of oral and rectal constipation treatment.</div></div><div><h3>Objective</h3><div>To explore children’s experiences of functional constipation and its treatments.</div></div><div><h3>Design</h3><div>A qualitative interview study with a constructionist epistemology and a predominantly experiential orientation.</div></div><div><h3>Setting</h3><div>Individual interviews were conducted in the child’s home, in the child’s familiar outpatient clinic, or on university premises. Open and permissive conversations about bowel habits, constipation, medical treatments, faecal leakage, and related feelings were digitally recorded and transcribed.</div></div><div><h3>Participants</h3><div>Twenty children (thirteen boys and seven girls) with functional constipation, aged 6–14 years, from four different outpatient clinics in southeast Sweden, who had experiences of oral and rectal medical treatments, were purposively recruited. Exclusion criteria were anorectal malformation or prior rectal surgery.</div></div><div><h3>Methods</h3><div>Transcripts were analysed using reflexive thematic analysis by Braun & Clarke.</div></div><div><h3>Findings</h3><div>This study provides a deeper understanding of why children choose not to go to the toilet. It explains how children perceive constipation treatment as simultaneously good and bad, and describes how faecal incontinence is strongly associated with the fear of exposure. The study also outlines the hopes and prospects of a cure. Four themes were created: 1) Procrastinating toilet visits – focus elsewhere, 2) Dreading exposure in a vulnerable position, 3) Enemas, a nightmare and a relief, 4) A doubtful hope during the treatment journey.</div></div><div><h3>Conclusions</h3><div>Care providers must acknowledge and validate the child’s perspective in constipation treatment situations. Our study provides an understanding of this perspective, which should be incorporated into clinical conversations with children about their diagnosis and proposed constipation treatment regimen. Adopting an approach that acknowledges children’s views based on this new information may enhance collaboration between care providers, parents, and children during constipation care.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105302"},"PeriodicalIF":7.1,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145583804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.ijnurstu.2025.105299
Wilfred Wing Fung Sin , Lily Man Lee Chan , Christine Tsz Ying Ng , Edmond Pui Hang Choi , Kris Yuet Wan Lok , Daniel Yee Tak Fong , Jojo Yan Yan Kwok
Background
Informal caregivers are integral to the long-term care of people with Parkinson's disease but often face substantial caregiving burden, which negatively affects both caregivers and care recipients. Despite its significance, there is no existing systematic review or meta-analysis that examines the significance of all potential factors using an appropriate conceptual framework.
Aim
To identify and analyze factors associated with caregiver burden in Parkinson's disease informal caregivers.
Design
Systematic review and meta-analysis.
Method
A comprehensive search of five databases was conducted from inception to February 2025. Eligible studies included those examining informal caregivers of people with Parkinson's disease, utilizing validated measures of caregiver burden, investigating at least one associated factor, and reporting associations as correlation or regression coefficients. The Stress-Appraisal Model was used to guide categorization of factors and evidence synthesis. Meta-analyses were performed using random-effects models.
Results
Sixty-six studies involving 30,533 people with Parkinson's disease and 30,419 informal caregivers were included. A total of 78 care recipient-level and 28 caregiver-level factors were identified, with 41 factors included in the meta-analyses. Care recipient-level factors including advanced disease stage, greater disability, longer disease duration, and more severe motor and non-motor symptoms, and caregiver-level factors such as greater psychological distress, longer time spent caregiving per day, older age, and poorer social support, were significantly associated with greater caregiver burden. Among all these factors, Parkinson's disease neuropsychiatric symptom severity and caregivers' psychological distress demonstrated the strongest positive associations with caregiver burden. Meta-regression revealed stronger associations in studies conducted in the Southeast Asia and Western Pacific regions.
Conclusion
Caregiver burden in Parkinson's disease informal caregivers is shaped by both care recipient- and caregiver-level factors, reflecting its multidimensional and complex nature. A paradigm shift in caregiver research and interventions is needed to emphasize modifiable caregiver-level and protective factors, such as caregiver psychological well-being, coping strategies, and social support, to alleviate burden and improve outcomes for the Parkinson's disease care dyads.
{"title":"Factors impacting caregiver burden in Parkinson's disease: A systematic review and meta-analysis","authors":"Wilfred Wing Fung Sin , Lily Man Lee Chan , Christine Tsz Ying Ng , Edmond Pui Hang Choi , Kris Yuet Wan Lok , Daniel Yee Tak Fong , Jojo Yan Yan Kwok","doi":"10.1016/j.ijnurstu.2025.105299","DOIUrl":"10.1016/j.ijnurstu.2025.105299","url":null,"abstract":"<div><h3>Background</h3><div>Informal caregivers are integral to the long-term care of people with Parkinson's disease but often face substantial caregiving burden, which negatively affects both caregivers and care recipients. Despite its significance, there is no existing systematic review or meta-analysis that examines the significance of all potential factors using an appropriate conceptual framework.</div></div><div><h3>Aim</h3><div>To identify and analyze factors associated with caregiver burden in Parkinson's disease informal caregivers.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Method</h3><div>A comprehensive search of five databases was conducted from inception to February 2025. Eligible studies included those examining informal caregivers of people with Parkinson's disease, utilizing validated measures of caregiver burden, investigating at least one associated factor, and reporting associations as correlation or regression coefficients. The Stress-Appraisal Model was used to guide categorization of factors and evidence synthesis. Meta-analyses were performed using random-effects models.</div></div><div><h3>Results</h3><div>Sixty-six studies involving 30,533 people with Parkinson's disease and 30,419 informal caregivers were included. A total of 78 care recipient-level and 28 caregiver-level factors were identified, with 41 factors included in the meta-analyses. Care recipient-level factors including advanced disease stage, greater disability, longer disease duration, and more severe motor and non-motor symptoms, and caregiver-level factors such as greater psychological distress, longer time spent caregiving per day, older age, and poorer social support, were significantly associated with greater caregiver burden. Among all these factors, Parkinson's disease neuropsychiatric symptom severity and caregivers' psychological distress demonstrated the strongest positive associations with caregiver burden. Meta-regression revealed stronger associations in studies conducted in the Southeast Asia and Western Pacific regions.</div></div><div><h3>Conclusion</h3><div>Caregiver burden in Parkinson's disease informal caregivers is shaped by both care recipient- and caregiver-level factors, reflecting its multidimensional and complex nature. A paradigm shift in caregiver research and interventions is needed to emphasize modifiable caregiver-level and protective factors, such as caregiver psychological well-being, coping strategies, and social support, to alleviate burden and improve outcomes for the Parkinson's disease care dyads.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105299"},"PeriodicalIF":7.1,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.ijnurstu.2025.105298
Lizhen Wang , Mu-Hsing Ho , Edmond Pui Hang Choi , Qianyi Zhang , Gongkai Xin , Juntao He , Chia-Chin Lin
<div><h3>Background</h3><div>Cancer-related cognitive impairment is prevalent in adult cancer survivors, negatively impacting their quality of life. Cognitive rehabilitation has emerged as a potential intervention to improve cancer related cognitive impairment. While several systematic reviews have been published primarily focusing on qualitative analysis, a comprehensive pairwise and network meta-analysis of randomized controlled trials is conducted to quantitatively synthesize and compare the effectiveness of various cognitive rehabilitation in improving cancer related cognitive impairment.</div></div><div><h3>Objective</h3><div>To synthesize and compare the current various cognitive rehabilitation interventions for improving either subjective or objective cognitive function in adult cancer survivors.</div></div><div><h3>Information sources</h3><div>We searched seven databases between January 1, 2010, and August 4, 2025.</div></div><div><h3>Methods</h3><div>This review adhered with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Two independent reviewers screened, extracted, and critically appraised the studies. Pairwise meta-analysis and network meta-analysis was performed to identify and compare different types of cognitive rehabilitation interventions. Cognitive rehabilitation interventions were categorized based on the use of technology and different cognitive rehabilitation approaches [i.e., cognitive training, compensatory strategy training, and combined cognitive rehabilitation]. Subgroup analysis, leave-one-out analysis, and meta-regression analysis were conducted to explore the robustness of the results and the potential moderators for intervention effectiveness.</div></div><div><h3>Results</h3><div>Thirty-one studies involving 2769 participants were included. The pooled results showed that cognitive rehabilitation achieved statistically significant small effect sizes for subjective cognitive function, and objective domains in visuospatial and motor function and language (<em>g</em> = 0.25 to 0.41). Statistically significant medium effect sizes were observed for total objective cognitive function, attention/concentration, executive function, and learning and memory (<em>g</em> = 0.51 to 0.77). Subgroup analyses demonstrated that non-technology cognitive rehabilitation was solely statistically more effective than technology-assisted cognitive rehabilitation in total objective function (<em>p</em> = 0.02), while differences among various cognitive rehabilitation approaches for all cognitive outcomes were non-significant. Network meta-analysis results showed technology-assisted compensatory strategy training, as broadly defined in this review, ranked highest for subjective cognitive function, while non-technology compensatory strategy training ranked highest for attention/concentration, and executive function. Technology-assisted cognitive training ranked highest for learning and memory. Meta-regression i
{"title":"Effectiveness of cognitive rehabilitation in improving subjective and objective cognitive functions in cancer patients: A systematic review, pairwise, and network meta-analysis of randomized controlled trials","authors":"Lizhen Wang , Mu-Hsing Ho , Edmond Pui Hang Choi , Qianyi Zhang , Gongkai Xin , Juntao He , Chia-Chin Lin","doi":"10.1016/j.ijnurstu.2025.105298","DOIUrl":"10.1016/j.ijnurstu.2025.105298","url":null,"abstract":"<div><h3>Background</h3><div>Cancer-related cognitive impairment is prevalent in adult cancer survivors, negatively impacting their quality of life. Cognitive rehabilitation has emerged as a potential intervention to improve cancer related cognitive impairment. While several systematic reviews have been published primarily focusing on qualitative analysis, a comprehensive pairwise and network meta-analysis of randomized controlled trials is conducted to quantitatively synthesize and compare the effectiveness of various cognitive rehabilitation in improving cancer related cognitive impairment.</div></div><div><h3>Objective</h3><div>To synthesize and compare the current various cognitive rehabilitation interventions for improving either subjective or objective cognitive function in adult cancer survivors.</div></div><div><h3>Information sources</h3><div>We searched seven databases between January 1, 2010, and August 4, 2025.</div></div><div><h3>Methods</h3><div>This review adhered with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Two independent reviewers screened, extracted, and critically appraised the studies. Pairwise meta-analysis and network meta-analysis was performed to identify and compare different types of cognitive rehabilitation interventions. Cognitive rehabilitation interventions were categorized based on the use of technology and different cognitive rehabilitation approaches [i.e., cognitive training, compensatory strategy training, and combined cognitive rehabilitation]. Subgroup analysis, leave-one-out analysis, and meta-regression analysis were conducted to explore the robustness of the results and the potential moderators for intervention effectiveness.</div></div><div><h3>Results</h3><div>Thirty-one studies involving 2769 participants were included. The pooled results showed that cognitive rehabilitation achieved statistically significant small effect sizes for subjective cognitive function, and objective domains in visuospatial and motor function and language (<em>g</em> = 0.25 to 0.41). Statistically significant medium effect sizes were observed for total objective cognitive function, attention/concentration, executive function, and learning and memory (<em>g</em> = 0.51 to 0.77). Subgroup analyses demonstrated that non-technology cognitive rehabilitation was solely statistically more effective than technology-assisted cognitive rehabilitation in total objective function (<em>p</em> = 0.02), while differences among various cognitive rehabilitation approaches for all cognitive outcomes were non-significant. Network meta-analysis results showed technology-assisted compensatory strategy training, as broadly defined in this review, ranked highest for subjective cognitive function, while non-technology compensatory strategy training ranked highest for attention/concentration, and executive function. Technology-assisted cognitive training ranked highest for learning and memory. Meta-regression i","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"174 ","pages":"Article 105298"},"PeriodicalIF":7.1,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号