Ask an answerable question (PICO)：
Patients with hepatocellular carcinoma are usually accompanied with symptoms such as pain, loss of appetite, fatigue, itching, and constipation et al. Therefore, it is an important goal of cancer care to find the effective ways to improve the disease or treatment related symptoms clusters. Tai Chi Qigong has been performing in China for thousands of years, it is unclear whether Tai Chi Qigong is effective in patients with liver cancer. The purpose of this article was to understand whether Tai Chi Qigong is effective for improving symptoms clusters of patients with hepatocellular carcinoma after surgery or treatment. An evidence-based nursing practice project was to examine the effectiveness of Tai Chi Qigong training on symptom relief of patients with hepatocellular carcinoma.
The Method and Analysis of Literature Review：
After forming an answerable question, a comprehensive literature search was used to retrieve the research articles which set keywords including cancer, tumor, malignant, Qigong, Tai Chi and symptoms. The database of Cochrane Library, PubMed, CINAHL, Medline, EBSCO and Airiti Library were used. Totally 6 ranked as evidence level 1 papers including 3 of systematic reviews and meta-analysis, 2 of systematic reviews and 1 of meta-analysis articles were selected from the period of published year from 2015 to 2020.
Critical Appraisal：
The CASP Systematic Review list (2018) was used as a tool to appraise the research quality, and the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence was used for ranking the level of evidence and strength of recommendations. Searching results: The intervention including Tai Chi, Qigong, acupressure, acupuncture and traditional five elements music, the average training time of 10-12 weeks , 3-4 times/week, 60-90 minutes/time, reported statistically significant effects on improving cancer fatigue, difficulty sleeping, depression, pain and quality of life. In addition, if it combined with acupressure, acupuncture or traditional five-element music, symptoms of diarrhea, bloating and bowel movements are statistically significant improved.
Clinical Application of Evidence：
The Knowledge Translation model was used to perform this project. A single group 12-week pre-post quasi experiment design was used. The first diagnosed early HCC patients from the medical or surgical wards in a medical center were invited. A 12-week Tai Chi Qigong training program was performed by 60-minitue per session and five times per week for 12 weeks. The checklist of symptom severity and 36-item short form health survey were used for data collected.
Evaluation of Effectiveness：
Results indicated that after the 12-week Tai Chi Qigong training program, the total scores of SF-36 health-related outcomes, mental health component scores and psychological health component scores were improved. The patients’ total reported severity of symptoms were relieved, the symptom of difficulty sleeping, pain, fatigue, depression and feelings of body tightness were also got improved.
Conclusions and Recommendations：
Tai Chi Qigong training is based on gentleness principle and health related element. It is safe, cost-effectiveness and feasible, could reduce symptom clusters and improve the health related quality of life. In a word, it would be recommended expanding this Tai Chi Qigong training intervention to cancer survivors and their caregiver to improve the quality of continuous care for patients and their family members.
