The effects of psychosocial interventions in cancer and heart disease: a review of systematic reviews

OBJECTIVE:

To conduct a review of existing systematic reviews, in order to (i) examine the types of psychosocial interventions that have been used with people suffering from heart disease or cancer, (ii) evaluate the effects of such interventions on physical outcomes, psychological outcomes or health care usage, and (iii) evaluate the methodological quality of the included systematic reviews.

METHODS:

A wide range of databases was searched for relevant systematic reviews of the literature. This process was supplemented by handsearching of 67 journals and contacting authors in the area. To be considered a “systematic review,” identified texts had to meet two criteria defined by CRD’s Database of Abstracts of Reviews of Effects (DARE), relating to the review question and literature search. Those that evaluated the effects of any kind of psychosocial intervention(s) in individuals with cancer or heart disease were included. Psychotropic medications, exercise training alone and 'black-box' interventions such as cardiac rehabilitation or interventions that included medical care such as secondary prevention through medication change were excluded. The quality of included reviews was assessed using a checklist adapted from that used for DARE. Two reviewers were involved in the review selection, extraction and quality assessment processes, with any disagreements resolved by a third reviewer.

The included reviews were combined in a narrative synthesis. Results were grouped by condition (heart disease and cancer) and, where possible, by type of intervention within each condition. Where results could not easily be classified by type of intervention, they were grouped according to outcome (psychological, physical, or other). Where possible, important differences between reviews and their potential effects on findings were highlighted. Within each section of the results, an overall summary of the methodological quality of the reviews is given and, where possible, emphasis is placed upon the reviews of higher quality. Implications for future primary research, as indicated in the included systematic reviews, have been summarised. The findings from the collection of reviews formed the basis of recommendations for the need, design and conduct of future systematic reviews in the area.