BACKGROUND Expressive writing involves writing about stressful or traumatic experiences. Despite trials in people with advanced disease, no systematic review to date has critiqued the evidence on expressive writing in this population. To synthesise the evidence of the effects of expressive writing on pain, sleep, depression and anxiety in people with advanced disease. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, CENTRAL, PsycINFO and PubMed were searched from January 1986 to March 2018. Other sources included clinical data registers and conference proceedings. Studies were included if they were randomised controlled trials that assessed the impact of an intervention involving expressive writing for adults with advanced disease and/or studies involving linguistic analysis on the expressive writing output. Methodological quality was assessed using the Cochrane risk of bias tool and the Mixed Methods Appraisal Tool. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the level of evidence for the outcomes of interest. The protocol of this systematic review has been registered on PROSPERO (CRD42017058193). RESULTS Six eligible studies with a total of 288 participants were identified, including four randomised controlled trials. All of the trials were in cancer and recruited predominantly women. None of the interventions were tailored to the population. Studies had methodological shortcomings and evidence was generally of low quality. Combined analysis of the four trials, involving 214 participants in total, showed no clear difference in the effect of expressive writing on sleep, anxiety or depression compared to an active control. Pain was not evaluated in the trials. In contrast, analysis of the four studies that included linguistic analysis alluded to linguistic mechanisms for potential effects. CONCLUSION Although the trial results suggest there is no benefit in expressive writing for people with advanced disease, the current evidence is limited. There is a need for more rigorous trials. It would be of benefit first to undertake exploratory research in trial design including how best to measure impact and in tailoring of the intervention to address the specific needs of people with advanced disease. TRIAL REGISTRATION The protocol of this systematic review has been registered on PROSPERO, which can be accessed here (registration number: CRD42017058193 ).

中文翻译：

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表达性写作作为晚期疾病患者的治疗干预：系统评价。

背景 表达性写作涉及关于压力或创伤经历的写作。尽管在晚期疾病患者中进行了试验，但迄今为止还没有系统评价批评过这一人群中表达性写作的证据。综合表达性写作对晚期疾病患者疼痛、睡眠、抑郁和焦虑影响的证据。方法 根据系统评价和元分析指南的首选报告项目进行系统评价。从 1986 年 1 月到 2018 年 3 月，对 CINAHL、CENTRAL、PsycINFO 和 PubMed 进行了检索。其他来源包括临床数据登记和会议记录。如果研究是评估涉及表达性写作干预对晚期疾病成人的影响的随机对照试验和/或涉及对表达性写作输出进行语言分析的研究，则纳入研究。使用 Cochrane 偏倚风险工具和混合方法评估工具评估方法学质量。建议分级评估、制定和评估工具用于评估相关结果的证据水平。该系统评价的方案已在 PROSPERO (CRD42017058193) 上注册。结果共确定了 6 项符合条件的研究，共有 288 名参与者，其中包括 4 项随机对照试验。所有的试验都是针对癌症的，并且主要招募女性。没有一项干预措施是针对人群量身定制的。研究存在方法学缺陷，证据质量普遍较低。对总共涉及 214 名参与者的四项试验的综合分析显示，与积极的对照组相比，表达性写作对睡眠、焦虑或抑郁的影响没有明显差异。在试验中没有评估疼痛。相比之下，对包括语言分析的四项研究的分析暗示了潜在影响的语言机制。结论 虽然试验结果表明，表达性写作对晚期疾病患者没有益处，但目前的证据有限。需要进行更严格的试验。首先在试验设计中进行探索性研究，包括如何最好地衡量影响和调整干预措施以满足晚期疾病患者的特定需求，这将是有益的。试用注册 本系统评价的方案已在 PROSPERO 上注册，可在此处访问（注册号：CRD42017058193）。