Psychological intervention and health education effects on quality of life in patients after pancreatic cancer surgery: A meta-analysis

Table 1 Methodological quality assessment of non-randomized studies using Newcastle-Ottawa Scale

Ref.	Selection	Comparability	Outcome
Zhang et al[27]	4	2	3
Gustavell et al[23]	4	2	3

Number indicates the score awarded to the study for corresponding item on Newcastle-Ottawa Scale.

Table 2 Summary of psychological interventions and health education measures

Ref.	Intervention type	Added to standard nursing (yes/no)	Description of intervention	Intervention (n)	Control (n)	Duration	Frequency	Outcome measure (quality of life)
Zhang et al[28]	WeChat support + education + team-based continuing nursing	Yes	Self-management manual for patients, setting up specialized outpatient chemotherapy ward, standardized electronic follow up archives, discharge guidance with recording instructions WeChat platform for science popularization, interaction, QA, and scheduling	50	50	Psychological	Follow-up and support were provided continuously from discharge onward via WeChat and scheduled admissions	QLQ-PAN26
Miao[26]	Comfort care	Yes	Monitored patients’ psychological changes; made targeted protocols to managed disorders. Communicated with families to boost confidence in treatment	68	68	Postoperative hospital stay period	Closely monitored psychology; timely family communication	SF-36
Zhang et al[27]	Triangle theory-based continuity of care	Yes	Nutritional education, dietary counseling, WeChat group support, online QA on postoperative care	70	114	3 months	Weekly telephone follow-ups, monthly home visits post-discharge; regular online QA	Pancreatic cancer 26 (QLQ-PAN26)
Gustavell et al[23]	Interactive application support, self-care advice, healthcare professional connection	Yes	Interaktor application: Reported symptoms daily at home; Continuous access to written evidence-based self-care advice; Links for more information, could connect with healthcare professionals	26	33	Up to six Months after surgery	Daily symptom reporting (with daily application reminders); nurse contact as needed for alert-generating symptoms. Median 3 alerts /patient in first 4 weeks, median 7 alerts/patient in rest period. Self-care advice median 13, 5 views first 4 weeks. 11 views/patient during rest period	EORTC QLQ-C30; QLQ-PAN26
Mi et al[24]	Mindfulness meditation (MM) + BrainLink intelligent biofeedback	Yes	Routine nursing plus MM combined with BrainLink intelligent biofeedback instrument	73	72	12 weeks	MM: Daily 20 minutes each time; BrainLink training: Conducted at time of first chemotherapy infusion, then on 4, 8, and 12 weeks thereafter	EORTC QLQ-C30
Wang and Wu[25]	Multidisciplinary specialized nursing care	Yes	Perioperative health education (written/oral/multimedia), psychological counseling, cognitive-behavioral interventions	44	44	1 year	Biweekly telephone calls 1 month after discharge. Monthly thereafter; 24-hour consultation	EORTC QLQ-C30

QA: Question and answer; QLQ-PAN26: Quality of life questionnaire-pancreatic cancer 26; SF-36: 36-Item Short Form Health Survey; EORTC QLQ-C30: European Organization for Research and Treatment of Cancer quality of life questionnaire-core 30; MM: Mindfulness meditation.

Table 3 Grading of recommendations assessment, development, and evaluation analysis

Outcome	Certainty assessment							Number of patients		Effect absolute (95%CI)	Certainty
	Number of studies	Study design	Risk of bias	Inconsistency	Indirect	Imprecise	Other considerations	IG	CG
Global health status	3	NR	Serious1,2,3	NS	NS	NS	None	142	149	MD = 7.12 (4.91 to 9.32)	Very low
Physical functioning	3	NR	Serious1,2,3	NS	NS	NS	None	137	145	SMD = 0.61 (0.37 to 0.85)	Very low
Emotional functioning	3	NR	Very serious1,2,3	NS	NS	NS	None	137	145	SMD = 1.03 (0.78 to 1.28)	Very low
Dietary digestion	2	NR	Serious1,2,3	NS	NS	NS	None	120	164	MD = -2.37 (-3.12 to -1.63)	Very low

¹Deviation from expected intervention measures.

²Outcome bias measurement.

³Missing data.

IG: Intervention; CG: Control; CI: Confidence interval; MD: Mean difference; NR: Nonrandomized; NS: Nonserious; SMD: Standardized mean difference.