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Nursing Support for Nausea and Vomiting in
Patients With Cancer: A Scoping Review
Masamitsu Kobayashi , Kohei Kajiwara , Miharu Morikawa , Yusuke Kanno , Kimiko Nakano ,
Yoshinobu Matsuda , Yoichi Shimizu , Taichi Shimazu , Jun Kako
1. Graduate School of Nursing Science, St. Luke’s International University, Tokyo, JPN 2. Faculty of Nursing, Japanese
Red Cross Kyushu International College of Nursing, Munakata, JPN 3. Graduate School of Medicine, Kyoto University,
Kyoto, JPN 4. Nursing Science, Tokyo Medical and Dental University, Tokyo, JPN 5. Clinical Research Center for
Developmental Therapeutics, Tokushima University Hospital, Tokushima, JPN 6. Department of Psychosomatic
Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, JPN 7. Faculty of Nursing,
National College of Nursing, Tokyo, JPN 8. Division of Behavioral Sciences, National Cancer Center Institute for Cancer
Control, National Cancer Center, Tokyo, JPN 9. Department of Nursing, Graduate School of Medicine, Mie University,
Mie, JPN
Corresponding author: Masamitsu Kobayashi, kobayashi.masamitsu.at@slcn.ac.jp
Abstract
Nausea and vomiting are symptoms commonly experienced by patients with advanced cancer and have a
wide range of causes, including pharmacological interventions. Additionally, multiple factors often
simultaneously cause nausea and vomiting. These highly distressing symptoms may be directly or indirectly
related to the disease and can significantly impact both the physical and psychological well-being of
patients. This study aims to identify the nursing support provided to reduce nausea and vomiting
experienced by patients with cancer. This study followed the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses Extension for Scoping Reviews checklist and Arksey and O’Malley’s framework.
We searched the PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane
Central Register of Controlled Trials in the Cochrane Library, and the Ichushi-Web of the Japan Medical
Abstract Society databases for all content published from the inception of each database through July 31,
2023. A total of 4,625 scientific articles were identified after literature screening. In total, 58 articles were
included for full-text review, and 10 articles were finally selected for review. The types of study designs
comprised six randomized controlled trials, three prospective observational studies, and one before-after
study with no controls. The types of cancers included in the articles were colorectal, breast, lung, pancreatic,
gynecological, stomach, and sarcoma. The total sample size of the study population was 793 patients (range
= 12-281) for intervention studies and 4,333 patients (range = 20-4,197) for observational studies. Nursing
support, extracted from the 10 articles, was classified into the following six types: massage therapy,
acupressure, early palliative care, psychosocial support, self-symptom monitoring, and coordinated care.
The review yielded six classifications of nursing support for nausea and vomiting in cancer patients. Future
research should examine the feasibility of providing nursing support for nausea and vomiting in cancer
patients.
Categories: Palliative Care, Pain Management, Oncology
Keywords: scoping review, terminally ill, quality of life, psychological support, cancer disease symptoms, nursing
support, nausea and vomiting, cancer
Introduction And Background
Nausea is an entirely subjective experience, defined as “the sensation (or sensations) that immediately
precede vomiting” [1]. Patients often state that they feel like they are about to vomit, feel “nauseous,” or
have an “upset stomach.” Vomiting is a highly specific physical event, defined as “the rapid, forceful
evacuation of gastric content in a retrograde fashion from the stomach up to and out of the mouth” [1].
Nausea and vomiting are symptoms commonly experienced by patients with advanced cancer [2,3] and have
a wide range of causes, including pharmacological therapy, such as anticancer drugs and opioids;
radiotherapy; abnormal, decreased, or enhanced gastrointestinal motility; and central nervous or
psychological causes [4,5]. Additionally, multiple factors often simultaneously cause nausea and vomiting
[1]. These highly distressing symptoms can be directly or indirectly related to the disease and can
significantly impact patients’ physical and psychological well-being [6].
The pathophysiology of nausea and vomiting is straightforward and is thought to involve mostly lower brain
structures without general involvement of the cerebral cortex or other areas of higher development. Nausea
and vomiting are a reflex triggered by toxic substances, such as chemotherapeutic agents, within the body
[7]. However, in the case of patients with advanced cancer, identifying and treating the cause of the disease
is often difficult or even impossible; hence, patient care is focused on providing symptomatic treatment.
Today, we have a multitude of options available, targeting various pathways, such as 5-HT3 receptor
antagonists, NK1 receptor antagonists, corticosteroids, anxiolytics and antipsychotics, and even
cannabinoids [8]. Therefore, antiemetics are recommended as the first choice of treatment for nausea and
1 2 3 4 5
6 7 8 9
Open Access Review
Article DOI: 10.7759/cureus.48212
How to cite this article
Kobayashi M, Kajiwara K, Morikawa M, et al. (November 03, 2023) Nursing Support for Nausea and Vomiting in Patients With Cancer: A Scoping
Review. Cureus 15(11): e48212. DOI 10.7759/cureus.48212
vomiting in patients with cancer [9-11]; however, concurrently incorporating non-pharmacological support
is thought to be useful in relieving distressing symptoms [9,12]. Previous studies have focused on non-
pharmacological support for treatment-related nausea and vomiting, including chemotherapy, in treatment-
phase patients with cancer [13-16]. However, additional research into non-pharmacological support for
nausea and vomiting in cancer progression is necessary to gain insights into these symptoms among
patients with terminal cancer.
Nursing support refers to non-pharmacological support provided by nurses, the healthcare professionals
expected to provide the best evidence-based practices. Previous studies have included patients with
chemotherapy-induced nausea and vomiting. The Oncology Nursing Society (ONS) guidelines provide
information on nursing support for chemotherapy-induced nausea and vomiting [17]. However, because of
insufficient evidence on nursing support for nausea and vomiting associated with cancer progression, it is
often provided based on nurses’ clinical experience. Hence, we conducted a comprehensive review of
research on nursing support for nausea and vomiting, which is not induced by medical therapies, among
patients with all stages of cancer. This was done to identify a broad range of nursing support approaches for
nausea and vomiting associated with cancer progression.
Review
Objective
We conducted a scoping review exploring practices currently used by nurses to reduce nausea and vomiting
in patients with cancer.
Methodology
To provide an overview of articles on nursing support for patients with cancer, we utilized the method
developed by Arksey and O’Malley [18] and conducted a scoping review, in accordance with the Preferred
Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews
(PRISMA-ScR) reporting guidelines and checklist [19]. In a scoping review, data are pooled from previously
conducted research (rather than by conducting a new quality assessment or critical appraisal) following a
five-step process: (i) identify the research question; (ii) identify relevant studies; (iii) select studies; (iv)
chart the data and major issues; and (v) collate, summarize, and report the results. Our scoping review
protocol [20] was published prospectively.
This study is a scoping review of nausea and vomiting, which are symptoms that were addressed in the
protocol paper. The definition of nursing support used in this study has been described in the protocol
paper. Briefly, it refers to the support that nurses can provide [20]. We, the authors of this review, held
discussions among ourselves to determine whether each type of support extracted from the published
studies met this standard (could be implemented by nurses caring for patients with advanced cancer)
according to the following procedure. First, if the care provider was a nurse, the care was identified as
nursing support. Next, if the support provider was not a nurse, the researchers, who were all nurses or
physicians, examined the support needs to determine whether nurses could implement the support in their
daily clinical practice. Each type of implementable support was identified as a type of nursing support.
Step 1: Identify the Research Question
In the first stage of the scoping review, we identified the key research question: What types of nursing
support are provided to reduce the nausea and vomiting experienced by patients with cancer?
Step 2: Identify Relevant Studies
We searched the PubMed, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central
Register of Controlled Trials in the Cochrane Library, and Ichushi-Web of the Japan Medical Abstract
Society databases for content published from the inception of each database through July 31, 2023. The
original search formulas were created while using PubMed, our initial search source. Subsequent search
formulas were created, as needed, to work with the remaining databases (see Appendix 1 of the protocol
paper for details) [20]. Two authors (MK and KK) completed the initial search in consultation with the
librarian.
Step 3: Select Studies
A scoping review was conducted according to the PRISMA-ScR guidelines. The eligibility criteria were
described in the protocol paper [20] and determined by physicians and nurses specializing in symptom
management for patients with cancer. Studies were included based on the following eligibility criteria: (i)
patients with cancer over 18 years of age, (ii) intervention or observational studies that focused on relieving
nausea and vomiting, (iii) nursing support, and (iv) quantitative data showing outcomes. We excluded papers
clearly showing that nausea and vomiting were caused by cancer treatment, papers in which over 20% of the
participants did not have cancer, papers with secondary analyses, and those published in languages other
2023 Kobayashi et al. Cureus 15(11): e48212. DOI 10.7759/cureus.48212 2 of 11
than Japanese or English. Literature on nausea and vomiting related to treatment was intentionally excluded
from this study to reduce the heterogeneity of the target population by focusing on nausea and vomiting
caused by advanced cancer disease-related symptoms.
The web-based application Rayyan, a software for systematic reviews that facilitates initial screening
through titles and abstracts, was used to analyze the identified articles [21]. The search results were
combined, and duplicates were removed. We checked the titles and abstracts of the extracted articles
according to the selection criteria. The full text of the extracted articles was then checked according to
eligibility criteria; articles that did not meet the criteria were excluded. In accordance with the search
strategy, the process of extracting literature was conducted independently by two authors (MK and KK).
Disagreements regarding inclusion were resolved by reaching a consensus through discussions between
these two authors.
Step 4: Chart the Data and Major Issues
A Microsoft Excel spreadsheet was used to organize the data from the collected articles. The input to the
spreadsheet was conducted by two independent authors (MK and KK). A form was created to extract the
study characteristics, including the first author, publication year, country, title, study design, sample size,
age, type of cancer, and outcome measurement tools. This study also extracted details about the nursing
support intervention or support program based on the following components: (i) type of support, (ii)
components, (iii) results of the interventions for nausea and vomiting, and (iv) population status (terminal
or not).
Step 5: Collate, Summarize, and Report the Results
The authors organized the collected data, classified them by group or summarized them, and reported them.
Data were imported into Microsoft Excel for validation and coding and summarized in a spreadsheet.
Results
The literature screening process and results are presented in Figure 1. As a result of the literature search
process, 4,625 scientific articles were extracted. After removing the duplicate articles, we reviewed the titles
and abstracts of 4,273 articles. This resulted in 58 articles being eligible for full-text review, of which 10 met
the selection criteria [22-31]. The agreement rate between the reviewers was 82.8% (48/58).
2023 Kobayashi et al. Cureus 15(11): e48212. DOI 10.7759/cureus.48212 3 of 11
FIGURE 1: PRISMA flow diagram.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PICO: Population, Intervention,
Comparison, and Outcomes
Summary of Study Characteristics
Table 1 summarizes the characteristics of the selected studies. Based on the types of study design, there were
six randomized controlled trials (RCTs), three prospective observational studies, and one before-after study
with no controls. The types of cancers included in the articles were colorectal (n = 6), breast (n = 5), lung (n =
5), pancreatic (n = 4), gynecological (n = 3), stomach (n = 3), and sarcoma (n = 3). The total sample size of the
study population was 793 patients (range: 12-281) for intervention studies and 4,333 patients (range: 20-
4,197) for observational studies. The measures of nausea and vomiting outcomes included the Edmonton
Symptom Assessment System Revised (n = 4), Visual Analog Scale (n = 3), Numerical Rating Scale (n = 1),
2023 Kobayashi et al. Cureus 15(11): e48212. DOI 10.7759/cureus.48212 4 of 11
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (n = 1),
and Spitzer Quality of Life Index (n = 1).
Author (publication
year)
Country Title Study design
Study
sample size
(n)
Participants’ age (years)
Anderson et al. (2021)
[22]
USA Foot reflexology: An intervention for pain and nausea among inpa tients with cancer RCT 40 Range: 18–80
Tsugita et al. (2021)
[23]
Japan
High feasibility and safety, but negligible efficacy of acupressure fo r treating nausea in cancer
patients admitted to the palliative care unit: a pilot study
Before-after
study
12 Mean (range) = 70 (56–87)
Perkins et al. (2020)
[24]
USA
Does acupressure help reduce nausea and vomiting in palliativ e care patients? A double-blind
randomized controlled trial
Observational
study
55 Intervention: mean = 65.5; Control: mean = 67.0
Fink et al. (2020) [25] UK
A quality brief of an oncological multisite massage and acupunctu re therapy program to improve
cancer-related outcomes
RCT 4197 Unknown
Zimmermann et al.
(2019) [26]
Canada
Phase 2 trial of symptom screening with targeted early palliative c are (STEP) for patients with
advanced cancer
Observational
study
116
Intervention: mean (MD) = 61.2 (±12.6); Control: mean
(MD) = 62.7 (±11.9)
Wang et al. (2015) [27] Taiwan The effect of abdominal massage in reducing malignant ascites symptoms RCT 80 Total: mean (MD) = 59.11 (35–83)
Arving et al. (2007)
[28]
Sweden
Individual psychosocial support for breast cancer patients: a ran domized study of nurse versus
psychologist interventions and standard care
RCT 179
Intervention: mean (range) = 55 (34–72) years; Control:
mean (range) = 55 (25–87)
Hoekstra et al. (2006)
[29]
Netherlands
Using the symptom monitor in a randomized controlled trial: the e ffect on symptom prevalence and
severity
RCT 146 Intervention: mean = 64.1; Control: mean = 64.6
Giasson and
Bouchard (1998) [30]
Canada Effect of therapeutic touch on the well-being of persons with termin al cancer
Observational
study
20 Total range: 38–68
Addington-Hall et al.
(1992) [31]
UK Randomised controlled trial of effects of coordinating care for terminally ill cancer pati ents RCT 281 Range: 18–(upper limit unknown)
TABLE 1: Summary of study characteristics.
Nursing Support Components
Nursing support extracted from the 10 articles was classified into six types: massage therapy (n = 4),
acupressure (n = 2), early palliative care (n = 1), psychosocial support (n = 1), self-symptom monitoring (n =
1), and coordinating care (n = 1). This support was delivered by nurses (n = 5), researchers (n = 4), physicians
(n = 1), and skill-trained therapists (n = 1). Seven articles included patients with terminal cancer. The types
of nursing support provided to terminally ill patients with cancer included massage therapy, acupressure,
early palliative care, self-symptom monitoring, and coordinating care. Details of the components of the
nursing support interventions and support programs are shown in Table 2.
2023 Kobayashi et al. Cureus 15(11): e48212. DOI 10.7759/cureus.48212 5 of 11
Type of
support
Component Provider
Includes
terminal
illness
Massage
therapy
[22,25,27,30]
Reflexology techniques were adopted from the Ingham method and included thumb and finger walking, hooking in, backing up, and rotating on the point; 15–20 minute/session Researcher ✕
Oncology massage consisting of Reiki (levels I & II), aromathera py, and guided relaxation exercises
Skill-trained
therapist
Unknown
The main massage maneuvers were straight rubbing (back a nd forth rubbing), point rubbing, and kneading; 15-minute gentle abdominal massage twice daily (at 7–8 a.m. and 4–5 p.m.)
for three consecutive days
Nurse
Used Rogers’s nursing conceptual model, Science of Unitary H uman Beings. Non-contact therapeutic touch is a consciously directed process of energy exchan ge during which the
hands are used as a focus to repattern the human energy field; 1 5–20 minutes/session, three times
Nurse
Acupressure
[23,24]
Neiguan and Zusanli were set as the acupressure sites. Acupre ssure was performed on each limb, with a pressure time of 30 seconds for each acupressure po int (three sets at each
acupressure point; total intervention time = 6 minutes)
Researcher
Acupressure on the P6 site with a wristband for three days Researcher
Early palliative
care [26]
A nurse-led telephone triage line was available, with after-hours p hysician telephone support ensuring 24/7 coverage. If needed, patients were referred for home nur sing care (in
conjunction with clinic visits)
Physician,
Nurse
Psychosocial
support [28]
First session: The patient was asked to discuss their disease his tory. Second session: The patient’s problems were identified; strategies—problem-solving, relaxat ion and distraction
techniques, ways to improve communication, activity schedulin g—that could help to manage these problems were taught to the patient
Nurse ✕
Self-symptom
monitoring [29]
The intervention consisted of a weekly patient self-assessment o f physical symptoms using the symptom monitor Researcher
Coordinating
care [31]
The coordinators were responsible for ensuring that patients rec eived appropriate and well-coordinated services that were tailored to their individual needs and circ umstances Nurse
TABLE 2: Nursing support components for nausea and vomiting.
Discussion
This study identified that nursing support reduces nausea and vomiting experienced by patients with cancer.
Based on the findings of the scoping review, we identified six classifications of nursing support approaches
to improve nausea and vomiting in patients with cancer.
Massage therapy, defined as therapeutic manipulation using the hands or mechanical devices to maintain
the suppleness of the body, was extracted from four of the 10 selected articles. Massage therapy is being
increasingly used for symptom relief in patients with cancer [32-34]. The specific content of support is foot
reflexology, multimodal care (care that combines Reiki levels, aromatherapy, and guided relaxation
exercises), abdominal massage, and therapeutic touch. Further, support methods have been implemented in
a wide variety of ways. Two of the four sessions were conducted by nurses, and three lasted approximately
15 minutes. Therefore, massage therapy is most likely implemented using a nurse-led approach. In addition,
this study considered it possible to incorporate massage therapy into the usual nursing care practice because
it can be provided in a short period. Further, the degree of invasiveness for the patient depends on the
intensity of the massage, but nursing support can be adapted regardless of the patient’s situation if
implemented according to the patient’s condition and preferences.
Acupressure was extracted from two of the 10 included articles. Specific support was provided to the
acupressure sites PC-6 and ST36, both of which were supported by acupressure for several minutes. These
sites are commonly used to treat nausea and vomiting. Previous studies have been conducted among
patients with cancer experiencing chemotherapy-induced nausea and vomiting [35]. The ONS [17]
guidelines regarding acupressure as a support approach for chemotherapy-induced nausea and vomiting are
summarized as “effectiveness not established,” as its effectiveness has not been clarified. Contrastingly, the
National Comprehensive Cancer Network [36] guidelines recommend acupressure as a type of self-
management support for nausea and vomiting. Therefore, acupressure could help reduce nausea and
vomiting in patients with cancer.
Early palliative care was extracted from one of the 10 articles. The specific support provided included nurse-
led symptom triage and support for symptom management, through multidisciplinary collaboration. Early
palliative care has been reported to improve the quality of life of patients with cancer [2,37]. Therefore, in
addition to improving the symptoms of nausea and vomiting, various other positive effects can be expected,
such as an improved quality of life. Consequently, early palliative care provided by a multidisciplinary team
2023 Kobayashi et al. Cureus 15(11): e48212. DOI 10.7759/cureus.48212 6 of 11
could help reduce nausea and vomiting in patients with cancer.
Psychosocial support was extracted from one of the 10 articles. The specific support provided included (a) an
assessment of emotional and social problems and (b) a discussion to resolve the problems. Nausea and
vomiting affect psychosocial aspects among patients with cancer [38,39]. These studies posit that physical
symptoms and psychosocial aspects are related; the researchers also suggest that psychosocial support can
be effective, regardless of the patient’s situation. Therefore, psychosocial support for patients with terminal
cancer could help reduce the physical, emotional, and social aspects of their disease-related nausea and
vomiting.
Self-symptom monitoring was extracted from one of the 10 articles. The specific support provided was for
patients to self-evaluate their symptoms and report the same to their healthcare providers once a week.
Monitoring their own symptoms could give patients a sense of control over their symptoms, which could
lead to symptom reduction [40,41]. Self-symptom monitoring can lead to the self-management of symptoms
and could be broadly helpful for symptoms other than nausea and vomiting. Self-symptom monitoring is
also considered an important support tool for self-care, early detection, and the treatment of symptoms.
Coordinating care was extracted from one of the 10 articles. The specific support provided was advice on
accessing local social services and promoting community linkages. In addition, in the included study,
coordinating care was provided by nurses. Patients could experience worsening symptoms of nausea and
vomiting, even when living in a community. Therefore, the role of the care coordinator is important for the
continuity of care. In addition, nurses actively provide medical care in various clinical settings such as local
communities and hospitals; thus, they may be ideal for coordinating care [42,43]. In this setting, this study
considers it important for healthcare providers to collaborate with each other and patients, to coordinate
patients with cancer, and to ensure that they receive appropriate social services, which meet their needs to
improve symptoms. Coordination could be helpful if a hardware environment is available to provide
support.
Seven of the 10 articles included terminally ill patients with cancer as the target population. In addition, five
of the six types of nursing support included studies on terminally ill patients with cancer. This study
intentionally excluded the literature on nausea and vomiting related to cancer treatment to avoid
heterogeneity. Consequently, most of the extracted literature focused on patients with terminal cancer.
Therefore, this study provides suggestions for nursing support for terminally ill patients with cancer as well
as all cancer progression stages. The degree of invasiveness, including adverse events, is an important factor
when considering the potential availability of nursing support for terminally ill patients with cancer [44].
Massage and acupressure have different degrees of invasiveness, depending on the intensity of their use.
However, nursing support could be applied for patients with terminal cancer, if implemented according to
patients’ conditions and preferences. Early palliative care, psychosocial support, self-symptom monitoring,
and coordinating care are not physically invasive; therefore, this could support oncology patients,
particularly those with terminal cancer. However, the applicability of these supports has not been verified.
Therefore, it is important to evaluate items such as complexity, compatibility, available resources, and
access to knowledge/information to determine their applicability to patients with cancer [45].
Finally, the number of RCTs was limited to six articles. Few clinical trials of nausea and vomiting related to
cancer progression have been conducted because of the complex and multicausal nature of nausea and
vomiting, respondent burden, and ethical issues [46]. Indeed, unlike cancer treatment-derived studies, there
is insufficient evidence for nausea and vomiting in relation to cancer progression [47,48]. Thus, future
research should examine the support for nausea and vomiting associated with cancer progression.
Additionally, five of the 10 articles were published in 2019 or later, suggesting that nursing support for
nausea and vomiting could have been the topic of much research attention in recent years. In addition, nine
of the 10 articles focused on various cancer types rather than a specific one. Therefore, although the
extracted support is versatile, it could be affected by the type of cancer.
This scoping review has several research limitations. First, it only included articles in English and Japanese;
hence, some relevant articles published in other languages could have been excluded. Second, it was not
designed to evaluate the quality of the studies. Therefore, this conclusion is not based on a synthesis of
evidence regarding nursing support for reducing nausea and vomiting. Third, the search was limited to
studies in which at least 80% of the participants were patients with cancer; thus, studies conducted primarily
on patients without cancer were excluded. The excluded studies could have presented evidence-supporting
treatments from non-specialized clinical practice.
Conclusions
This scoping review comprehensively explored the nursing support provided to reduce nausea and vomiting
in patients with cancer. The results of this scoping review classified nursing support for nausea and vomiting
in patients with cancer into six types, namely, massage therapy, acupressure, early palliative care,
psychosocial support, self-symptom monitoring, and coordinating care. In addition, most of the extracted
literature focused on patients with terminal cancer. Therefore, this study provides suggestions for nursing
support for terminally ill patients with cancer as well as all cancer progression stages. Future research should
2023 Kobayashi et al. Cureus 15(11): e48212. DOI 10.7759/cureus.48212 7 of 11
examine the feasibility of implementing these types of nursing support for nausea and vomiting in patients
with terminal cancer, with a prognosis of months or weeks while also exploring effective prognosis-based
nursing support. Finally, the study goal was to map nursing support for nausea and vomiting. Therefore, we
did not assess the quality of individual studies or examine the effectiveness of interventions. Future research
could benefit from assessing the quality of individual studies and testing the effectiveness of interventions.
Appendices
Section Item PRISMA-ScR checklist item
Reported
on page #
Title
Title 1 Identify the report as a scoping review. Title page
Abstract
Structured summary 2
Provide a structured summary that includes (as applicable): ba ckground, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclus ions that relate
to the review questions and objectives.
abstract
Introduction
Rationale 3 Describe the rationale for the review in the context of what is alread y known. Explain why the review questions/objectives lend themselves to a scoping review appro ach. P2-3
Objectives 4
Provide an explicit statement of the questions and objectives bein g addressed with reference to their key elements (e.g., population or participants, concepts, and con text) or
other relevant key elements used to conceptualize the review q uestions and/or objectives.
P3
Methods
Protocol and registration 5
Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the re gistration
number.
P3
Eligibility criteria 6 Specify characteristics of the sources of evidence used as eligib ility criteria (e.g., years considered, language, and publication status), and provide a rationale. P3
Information sources* 7
Describe all information sources in the search (e.g., databases w ith dates of coverage and contact with authors to identify additional sources), as well as the date the m ost
recent search was executed.
P4
Search 8 Present the full electronic search strategy for at least 1 database, in cluding any limits used, such that it could be repeated.
P4
(protocol
paper)
Selection of sources of
evidence†
9 State the process for selecting sources of evidence (i.e., screenin g and eligibility) included in the scoping review. P4
Data charting process‡ 10
Describe the methods of charting data from the included source s of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether
data charting was done independently or in duplicate) and any p rocesses for obtaining and confirming data from investigators.
P4-5
Data items 11 List and define all variables for which data were sought and any a ssumptions and simplifications made. P4
Critical appraisal of individual
sources of evidence§
12
If done, provide a rationale for conducting a critical appraisal of inc luded sources of evidence; describe the methods used and how this information was used in any data
synthesis (if appropriate).
P2-3
Section Item PRISMA-ScR checklist item
Reported
on page #
Synthesis of results 13 Describe th e methods of handling and summarizing the data that were charted. P5
RESULTS
Selection of sources of
evidence
14 Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow di agram.
Figure 1,
P5
Characteristics of sources of
evidence
15 For each source of evidence, present characteristics for which data were charted and provide the citations.
Table 1,
P5-6
Critical appraisal within
sources of evidence
16 If done, present data on critical appraisal of included sources of ev idence (see item 12). -
Results of individual sources
of evidence
17 For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives.
Table 1,
P5-6
Synthesis of results 18 Summariz e and/or present the charting results as they relate to the review questions and objectives.
Table 2,
P5-6
2023 Kobayashi et al. Cureus 15(11): e48212. DOI 10.7759/cureus.48212 8 of 11
Discussion
Summary of evidence 19
Summarize the main results (including an overview of concepts , themes, and types of evidence available), link to the review questions and objectives, and conside r the
relevance to key groups.
P6-8
Limitations 20 Discuss the limitations of the scoping review process. P8-9
Conclusions 21 Provide a general interpretation of the results with respect to the re view questions and objectives, as well as potential implications and/or next steps. P9
Funding
Funding 22 Describe sources of funding for the included sources of evidenc e, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review. P10
JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Ite ms for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. * Where sources of evidence (see second footnote) are compiled from, such as
bibliographic databases, social media platforms, and Web sites. † A more inclusive/heterogeneous term used to account for the different types of evidence or data s ources (e.g., quantitative and/or qualitative research, expert opinion, and
policy documents) that may be eligible in a scoping review as op posed to only studies. This is not to be confused with information sources (see first footnote). ‡ The fra meworks by Arksey and O’Malley (6) and Levac and colleagues (7)
and the JBI guidance (4, 5) refer to the process of data extraction in a scoping review as data charting. § The process of systematically examining research evidenc e to assess its validity, results, and relevance before using it to inform a
decision. This term is used for items 12 and 19 instead of "risk of b ias" (which is more applicable to systematic reviews of interventions) to include and acknowledg e the various sources of evidence that may be used in a scoping review
(e.g., quantitative and/or qualitative research, expert opinion, and p olicy document).
From: Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D , et al. PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation. Ann Intern M ed. 2018;169:467–473. doi: 10.7326/M18-0850.
TABLE 3: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for
Scoping Reviews (PRISMA-ScR) Checklist.
Additional Information
Author Contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the
work.
Concept and design: Masamitsu Kobayashi, Kohei Kajiwara, Miharu Morikawa, Yusuke Kanno, Kimiko
Nakano, Yoshinobu Matsuda, Yoichi Shimizu, Taichi Shimazu, Jun Kako
Acquisition, analysis, or interpretation of data: Masamitsu Kobayashi, Kohei Kajiwara
Drafting of the manuscript: Masamitsu Kobayashi
Critical review of the manuscript for important intellectual content: Masamitsu Kobayashi, Kohei
Kajiwara, Miharu Morikawa, Yusuke Kanno, Kimiko Nakano, Yoshinobu Matsuda, Yoichi Shimizu, Taichi
Shimazu, Jun Kako
Supervision: Masamitsu Kobayashi, Jun Kako
Disclosures
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following: Payment/services info: The authors disclose receipt of the following financial support for the
research, authorship, and/or publication of this article: This work was supported by JSPS KAKENHI (grant
number 21H03236). The funders had no role in the study design, data collection and analysis, decision to
publish, or manuscript preparation. Financial relationships: All authors have declared that they have no
financial relationships at present or within the previous three years with any organizations that might have
an interest in the submitted work. Other relationships: All authors have declared that there are no other
relationships or activities that could appear to have influenced the submitted work.
Acknowledgements
We thank Editage (www.editage.jp) for English language editing. This study received guidance from the
National Center Consortium in Implementation Science for Health Equity (N-EQUITY), funded by the Japan
Health Research Promotion Bureau (JH) Research Fund (2019-(1)-4) and JH Project fund (JHP2022-J-02).
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