Nursing interventions to promote patient engagement in cancer care: A systematic review

Abstract

Background: Patient engagement is becoming increasingly relevant in cancer care. Nurses have been recognized as crucial in promoting active engagement of people with carcer. Despite the growing interest on this topic and the relevance of patient engagement interventions to improve patient' conditions, to the best of our knowledge there is no synthesis of the literature on the characteristics and impact of nurse-led patient engagement intervention for adults with cancer.

Objective: This review aims to systematically summarize nurse-led patient engagement interventions for adult patients diagnosed with cancer and to describe the state of the art on the impact of these interventions on patients' outcomes.

Design: Systematic review.

Setting(s): Hospital and outpatient care.

Participants: Adults with cancer.

Methods: We searched PubMed, CINAHL, Embase, Scopus, Web of Science and Cochrane library from 2005 to 2021. We included randomized clinical trials, quasi-experimental studies and single-arm, pre-test/post-test studies written in English, Spanish, French and Italian. All the included articles reported nurse-led patient engagement interventions designed to improve patient engagement in the management of their own disease and to assess outcomes related to patient engagement. We appraised the methodological quality of the included articles with the Joanna Briggs Institute appraisal tools.

Results: Twenty-four articles met the inclusion criteria. Four distinct types of nurse-led engagement interventions, showing different degrees of complexity, were classified: (i) generic health information delivery, (ii) patient-specific information delivery, (iii) personalized decision support and (iv) motivational support. These interventions were effective in supporting behavioral changes and reducing symptoms burden of adults with cancer. In addition, many of the retrieved studies showed significant increase in patients' knowledge, informed decisions making, perceived quality of nurse-patient interaction and quality of life after the engagement intervention.

Conclusions: This systematic review summarized a wide variety of nurse-led patient engagement interventions with different degrees of complexity. In addition, a significant positive effect of these interventions was found on outcomes such as patient activation, self-efficacy, health literacy and quality of life. Among those identified, nurse-led motivational interventions appear to be the most effective ones for improving engagement outcomes in adults with cancer.

Registration number: PROSPERO Nr: CRD42020146189.

Keywords: Empowerment; Neoplasm; Non-randomized controlled trials; Nurse; Patient engagement; Patient involvement; Patient participation; Randomize control trial; Systematic review.