A review of comfort interventions to promote patient comfort during radiotherapy

Introduction: Comfort is linked to care in all clinical procedures, but there are specific areas in which it takes on a particular importance such as radiotherapy1-4. During radiotherapy, there is a need for patient stability and alignment for precise clinical delivery which challenges patient comfort. This review aimed to search the literature to identify comfort interventions used for clinical procedures that involve remaining still, describes these comfort interventions and determine whether these comfort interventions are useful. Methods: The review is structured and reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement5. Four databases, EMBASE, CINAHL,AHMED and Psycinfo were searched for controlled trials. Cochrane Risk of Bias (RoB) was used to evaluate paper quality. Intervention characteristics6 were examined and outcome data evaluated for clinical significance based on the following criteria: effect size ≥0.4 7and an outcome ≥ Minimal Important Difference for the measure8. The protocol was prospectively published on the PROSPERO international register for systematic reviews9 to avoid duplication (CRD42017059688). Results: 5,269 titles and abstracts were screened; 47 RCTs met the inclusion criteria. Thirteen different interventions were reported in 5 broad categories’. 26 studies using validated outcome measures were included in the data synthesis (Table.1). Conclusion: Several interventions were identified that may improve comfort for clinical procedures that require patients to remain stable and for precision required for procedures such as radiotherapy. Further investigation of these comfort interventions is warranted, including determining if multiple interventions can be used concurrently to improve their effectiveness. Table 1. [Formula presented] Numerical References KEY REFERENCES [100 in total - reference list supplied] 1)Goldsworthy. S, Mundy. K, Latour. JM. A focus group consultation round exploring patient experiences of comfort during radiotherapy for head and neck cancer; Journal of Radiotherapy in Practice. 2016. Vol 15, issue 2, Pp143-149 2)Kolcaba KY. A taxonomic structure for the concept comfort. Image J Nurs Sch. 1991 Winter;23(4):237-40 3) Kolcaba KY. Holistic comfort: operationalizing the construct as a nurse-sensitive outcome. ANS Adv Nurs Sci. 1992 Sep;15(1):1-10 4) Kolcaba KY. A theory of holistic comfort for nursing. J Adv Nurs. 1994 Jun;19(6):1178-84 5) Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009 Oct;62(10):1006-12 6) Hoffmann TC, Glasziou PP, Boutron I, et al. Better Reporting of Interventions: Template for Intervention Description and Replication (TIDieR) Checklist and Guide. Gesundheitswesen. 2016 Mar;78(3):e174 7) Rice ME, Harris GT, Comparing effect sizes in follow-up studies: ROC Area, Cohen's d, and r. Law Hum Behav. 2005 Oct;29(5):615-20. 8) Corsaletti.B.F, Mahara-Daian Garcia Lemes Proença.M_D.F>L, Gianna Kelren Waldrich Bisca.G.K.W et al. Minimal important difference for anxiety and depression surveys after intervention to increase daily physical activity in smokers. Fisioter Pesq. 2014;21(4):359-364 9) Centre for Reviews and Dissemination (CRD). Systematic reviews:CRD’s guidance for undertaking reviews in health care. York Publishing Services Ltd. 2009 Jan. 1-294.