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      Self-management of patients with advanced cancer: A systematic review of experiences and attitudes


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          Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention.


          To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management.


          A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting.

          Data sources:

          MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019).


          Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient–professional partnerships (three articles).


          Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals.

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          Most cited references66

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          Self-management education: history, definition, outcomes, and mechanisms.

          Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks--medical management, role management, and emotional management--and six self-management skills--problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems.
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            Depression and poor glycemic control: a meta-analytic review of the literature.

            Depression is common among patients with diabetes, but its relationship to glycemic control has not been systematically reviewed. Our objective was to determine whether depression is associated with poor glycemic control. Medline and PsycINFO databases and published reference lists were used to identify studies that measured the association of depression with glycemic control. Meta-analytic procedures were used to convert the findings to a common metric, calculate effect sizes (ESs), and statistically analyze the collective data. A total of 24 studies satisfied the inclusion and exclusion criteria for the meta-analysis. Depression was significantly associated with hyperglycemia (Z = 5.4, P < 0.0001). The standardized ES was in the small-to-moderate range (0.17) and was consistent, as the 95% CI was narrow (0.13-0.21). The ES was similar in studies of either type 1 or type 2 diabetes (ES 0.19 vs. 0.16) and larger when standardized interviews and diagnostic criteria rather than self-report questionnaires were used to assess depression (ES 0.28 vs. 0.15). Depression is associated with hyperglycemia in patients with type 1 or type 2 diabetes. Additional studies are needed to establish the directional nature of this relationship and to determine the effects of depression treatment on glycemic control and the long-term course of diabetes.
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              Defining and Designing Mixed Research Synthesis Studies.

              Mixed research synthesis is the latest addition to the repertoires of mixed methods research and systematic review. Mixed research synthesis requires that the problems generated by the methodological diversity within and between qualitative and quantitative studies be resolved. Three basic research designs accommodate this diversity, including the segregated, integrated, and contingent designs. Much work remains to be done before mixed research synthesis can secure its place in the repertoires of mixed methods research and systematic review, but the effort is well worth it as it has the potential to enhance both the significance and utility for practice of the many qualitative and quantitative studies constituting shared domains of research.

                Author and article information

                Palliat Med
                Palliat Med
                Palliative Medicine
                SAGE Publications (Sage UK: London, England )
                2 February 2020
                February 2020
                : 34
                : 2
                : 160-178
                [1 ]Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
                [2 ]Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
                [3 ]NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
                [4 ]Amsterdam Public Health (APH) Research Institute, VU University Medical Center, Amsterdam, The Netherlands
                [5 ]Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
                Author notes
                [*]Judith AC Rietjens, Department of Public Health, Erasmus University Medical Center, Rotterdam 3015 GD, The Netherlands. Email: j.rietjens@ 123456erasmusmc.nl

                SI van Dongen and K de Nooijer shared first authorship due to equal contribution to the manuscript.

                Author information
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                Anesthesiology & Pain management
                cancer,palliative care,integrative oncology,nursing,self-care,self-management,quality of life,systematic review


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