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Self‐management programmes for cirrhosis: A systematic review

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  • Samuel Boudreault
  • Junqiao Chen
  • Kevin Y. Wu
  • Annette Plüddemann
  • Carl Heneghan

Abstract

Background and aims Liver cirrhosis severely decreases patients' quality of life. Since self‐management programmes have improved quality of life and reduce hospital admissions in other chronic diseases, they have been suggested to decrease liver cirrhosis burden. Methods We performed a systematic review and meta‐analysis to evaluate the clinical impact of self‐management programmes in patients with liver cirrhosis, which followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Primary outcomes include health‐related quality of life (HRQOL) and hospitalisation. We searched MEDLINE, CENTRAL, Embase, CINAHL, PsycINFO and two trial registers to July 2017. Results We identified four randomised trials (299 patients) all rated at a high risk of bias. No difference was demonstrated for HRQOL (standardised mean difference −0.01, 95% CI: −0.48 to 0.46) and hospitalisation days (incidence rate ratio 1.6, 95% CI: 0.5–4.8). For secondary outcomes, one study found a statistically significant improvement in patient knowledge (mean difference (MD) 3.68, 95% CI: 2.11–5.25) while another study found an increase in model for end‐stage liver disease scores (MD 2.8, 95% CI: 0.6–4.9) in the self‐management group. No statistical difference was found for the other secondary outcomes (self‐efficacy, psychological health outcomes, healthcare utilisation, mortality). Overall, the quality of the evidence was low. The content of self‐management programmes varied across studies with little overlap. Conclusions The current literature indicates that there is no evidence of a benefit of self‐management programmes for people with cirrhosis. Relevance to clinical practice Practitioners should use self‐management programmes with caution when delivering care to patients living with cirrhosis. Further research is required to determine what are the key features in a complex intervention like self‐management. This review offers a preliminary framework for clinicians to develop a new self‐management programme with key features of effective self‐management interventions from established models.

Suggested Citation

  • Samuel Boudreault & Junqiao Chen & Kevin Y. Wu & Annette Plüddemann & Carl Heneghan, 2020. "Self‐management programmes for cirrhosis: A systematic review," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(19-20), pages 3625-3637, October.
    • Handle: RePEc:wly:jocnur:v:29:y:2020:i:19-20:p:3625-3637
    DOI: 10.1111/jocn.15416
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    References listed on IDEAS

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    1. Sasha Shepperd & Simon Lewin & Sharon Straus & Mike Clarke & Martin P Eccles & Ray Fitzpatrick & Geoff Wong & Aziz Sheikh, 2009. "Can We Systematically Review Studies That Evaluate Complex Interventions?," PLOS Medicine, Public Library of Science, vol. 6(8), pages 1-8, August.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    1. Timmermans, Lotte & Golder, Elena & Decat, Peter & Foulon, Veerle & Van Hecke, Ann & Schoenmakers, Birgitte, 2023. "Characteristics of self-management support (SMS) interventions and their impact on Quality of Life (QoL) in adults with chronic diseases: An umbrella review of systematic reviews," Health Policy, Elsevier, vol. 135(C).

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