This review found that educational self-care strategies for people with advanced cancer were useful in helping patients cope with pain and adjust psychologically to their life-limiting illness. Some methodological flaws and a lack of information about the results mean that the authors' conclusions should be interpreted with caution.

To assess the clinical effectiveness of interventions for managing the illness of patients by themselves who were experiencing end-of-life care at advanced stages of cancer.

This abstract addresses the clinical effectiveness of interventions that met DARE criteria.

MEDLINE, ASSIA, CINAHL PsycINFO, Social Science Citation Index and Web of Science databases and Google Scholar were searched from 1996 to December 2008 for relevant English-language studies; search terms were reported. The authors searched for unpublished studies using Index to Theses. Department of Health End of Life programme, Gold Standards Framework and End of Life Observatory at the University of Lancaster websites were searched. Reference lists of all retrieved articles were searched for additional studies.

Studies that investigated self care or self management interventions in adults with advanced or metastatic cancer during palliative care at the end of life with cancer were eligible for inclusion. Studies of children, other family members, health professionals and patients who underwent active treatment were excluded.

Patients had a range of cancers that included: breast cancer and other gynaecological system cancers; melanoma; lymphatic system malignancies and leukaemia; myeloma; prostatic cancers; head and neck cancers; bladder and kidney cancers; and lung cancer. Many patients were experiencing pain from metastatic cancer. The interventions reviewed included studies of education programmes and symptom-focused interventions. The symptom-focused interventions were focused on reducing symptom distress and improvement of symptoms in both clinical and psychological symptoms. Self-care behaviours included information support, social support, self care, medication administration, creative activity and use of complementary and alternative therapies. All interventions were administered by nurses in homes, hospices or outpatient clinics.

The authors did not state how many reviewers performed the study selection.

The assessment of methodological quality was conducted using Dixon and Woods criteria for aims of the research, specification of research design, clarity of process, presentation of results and appropriateness of analysis.

The authors did not state how many reviewers performed the quality assessment.

Data were extracted into standardised data extraction forms.

It was unclear how many reviewers extracted data.

The results were summarised in a narrative review.

Eighteen studies (n=1,447) were included in the review: five surveys, three randomised controlled trials (RCT), six qualitative studies, two quasi-experimental studies, one process evaluation and one mixed methods study. The qualitative studies used interviews, focus groups or structured health diaries. Sample sizes ranged from eight to 189. All studies escept one received a 5 out of 5 quality rating; one study was rated 3 out of 5. Seven studies evaluated interventions for end of life care (n=839).

Interventions for end of life care: One RCT (n=189) found that educational programmes with a cognitive-behavioural approach were more successful in improving care by improving control, knowledge and attitudes to pain medication and improving communication with professionals about pain. Pain levels were significantly reduced.

Two RCTs (n=366) investigated symptom-focused interventions. Both these studies reported reduced symptom distress and improvements in pain and psychological symptoms and information. One RCT found patients were more prepared for end of life.

Activities for patients with advance cancer were more likely to be beneficial if they were symptom-focused and provided education and information to help people manage pain and debilitating symptoms.

The review addressed a clear question. Criteria for inclusion of studies were outlined. Appropriate electronic databases were searched and some attempts were made to identify unpublished literature. The review was limited to studies published in English, so there was a risk of language biases. It was unclear whether steps were taken to minimise reviewer errors and bias throughout the review process. No appropriate criteria were used to assess the quality of the RCTs, although the authors discussed some aspects of study quality such as sample size and blinding. The heterogeneity of study designs, interventions and patient conditions was such that the decision of the authors to assess the studies qualitatively was justified. No information was provided on the size of the effects found in studies that reported benefits of interventions.

The authors' conclusions were based on the evidence presented, but an absence of information on results and some methodological flaws mean that the authors' conclusions should be interpreted with caution and the reliability of the results is unclear.

Practice: The authors stated that self-care strategies for people with advanced disease should be implemented to help patients with pain and debilitating symptoms cope emotionally and adjust psychologically to their illness. Education programmes in particular were shown to be effective.

Research: The authors stated that further research was required into how people in UK managed life-limiting conditions themselves at the end of life.

Medical Research Scotland; Mrs Mary Tyson Medical Research Scotland Research Fellowship.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.