Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

Background
Anorexia nervosa in adolescents can be a difficult-to-treat disease. Because qualitative research is a well-established method for deepening our understanding of subjective experiences, such as eating disorders and their treatment, we sought to perform a systematic review of qualitative studies to synthesize the views of adolescents with this disease, their parents, and their healthcare providers about its treatment.
Methods
We performed a thematic synthesis to develop the central themes that summarize all of the topics raised in the articles included in our review. The quality of the articles was assessed by the Critical Appraisal Skills Program.
Results
We included 32 articles from seven different countries. Two central themes were inductively developed from the analysis: (1) the treatment targets (i.e., symptoms and patients in context), and (2) a therapeutic tool—a relationship, specifically the core concept of the therapeutic relationship.
Conclusion
Our results underline the difficulty in establishing a therapeutic alliance, the barriers to it, especially the risk that professionals, adolescents, and parents will not converse about treatment; although such a dialogue appears to be an essential component in the construction of a therapeutic alliance.

背景
青少年神经性厌食症是一种难治性疾病。由于质性研究是深化我们对进食障碍及其治疗等主观体验理解的成熟研究方法，本研究旨在开展一项质性研究系统综述，以整合该病青少年患者、其家属及医疗照护提供者针对该病治疗的相关观点。

方法
本研究采用主题合成法，提炼综述纳入文献中所提及的所有议题的核心主题。文献质量采用关键评价技能计划（Critical Appraisal Skills Program）进行评估。

结果
本综述共纳入来自7个不同国家的32篇文献。通过归纳分析，我们提炼出两大核心主题：(1) 治疗目标（即症状与情境化患者）；(2) 治疗工具——医患关系，具体为治疗关系的核心内涵。

结论
本研究结果凸显了建立治疗联盟的难度及其阻碍因素，尤其突出的风险是医护人员、青少年患者与家属无法就治疗议题展开沟通；尽管此类沟通似乎是构建治疗联盟的必要组成部分。