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 ). Electronic supplementary material The online version of this article (10.1186/s12904-019-0449-y) contains supplementary material, which is available to authorized users.

Οι ερευνητές πραγματοποίησαν μια ανασκόπηση της βιβλιογραφίας για τις αντιλήψεις και στάσεις των εκπαιδευτικών για την ένταξη των μαθητών/ριών με Διαταραχές Αυτιστικού Φάσματος (ΔΑΦ). Για να βρουν τις σχετικές με το θέμα έρευνες διεξήγαγαν αναζήτηση στις βάσεις δεδομένων ERIC, PsychLIT, EBSCO, Medline, και PubMed με τις λέξεις-κλειδιά «Εκπαιδευτικοί», «Αντιλήψεις», «Στάσεις», και «Παιδιά με Αυτισμό». Από την αναζήτηση βρέθηκαν 55 ερευνητικά άρθρα, μεταπτυχιακές και διδακτορικές διατριβές σχετικά με το θέμα τους. Τα αποτελέσματα έδειξαν ότι η πλειοψηφία των εκπαιδευτικών έχει περιορισμένη ή ανεπαρκή γνώση και βασικές παρανοήσεις σχετικά με τις Διαταραχές Αυτιστικού Φάσματος. Επίσης, οι εκπαιδευτικοί είχαν αρνητικές στάσεις απέναντι στην ένταξη των μαθητών/ριών με αυτισμό. Από την άλλη πλευρά, λιγότεροι/ες εκπαιδευτικοί φάνηκε ότι έχουν θετικές στάσεις στην ένταξη αυτών των μαθητών/ριών. Ένα μεγάλο ποσοστό των εκπαιδευτικών φάνηκε να έχει διαφορετικές στάσεις/απόψεις για τον αυτισμό. Επιπλέον, η ανασκόπηση έδειξε ότι μερικοί/ές εκπαιδευτικοί τείνουν να έχουν ουδέτερες στάσεις προς την ένταξη αυτής της ομάδας μαθητών/ριών. Επιπλέον, αρκετοί/ές εκπαιδευτικοί αντιλαμβάνονται τους/τις μαθητές/ριες με αυτισμό διαφορετικά από τους/τις τυπικά αναπτυσσόμενους/ες μαθητές/τριες. Η έρευνα αυτή υποδεικνύει ότι οι εκπαιδευτικοί πρέπει να λάβουν περισσότερη κατάρτιση για τον αυτισμό και τις αποτελεσματικές εκπαιδευτικές πρακτικές για αυτούς/ές τους/τις μαθητές/ριες. Με αυτόν τον τρόπο, οι ίδιοι/ες θα αναπτύξουν θετικές στάσεις προς την εκπαιδευτική ένταξη αυτών των μαθητών/ριών.

IntroductionTherapeutic emotional disclosure has been associated with positive psychological, physiological and behavioural changes.1In the form of expressive writing it commonly involves writing about a traumatic experience for 15 min over 3–5 consecutive days.2There is evidence that expressive writing in people with cancer may reduce pain and improve energy levels, sleep and psychological symptoms.3It has not been established in a review whether these interventions benefit people with advanced disease.AimsTo critique and pool the evidence from randomised controlled trials (RCTs) and other comparative studies on the effectiveness of emotional disclosure in adults with advanced disease and to explore the text analysis of participant’s emotional disclosure.MethodFour databases (Pubmed, CENTRAL, CINAHL, PsycINFO), conference proceedings and a trials register were searched for relevant studies in March 2017. A combination of MeSH and free-text terms on emotional disclosure and end-of-life were used. Key review processes will be undertaken in duplicate. If appropriate meta-analysis will be considered.ResultsThe search identified unique 9014 citations. Screening these identified 33 potential relevant studies. Following full text review and contact with authors to clarify their sample population, nine studies on expressive writing met our inclusion criteria. Six were RCTs and three provide text analysis of emotional disclosure responses.ConclusionThis review is at data extraction phase, it will be completed (as part of an Msc) by September. The findings will provide best evidence on whether a relatively simple intervention can help improve the wellbeing of people with advanced disease.References. Pennebaker, J.W., 1997. Writing about emotional experiences as a therapeutic process. Psychological Science, 8(3), pp.162–166.. Pennebaker, J.W. and Beall, S.K., 1986. Confronting a traumatic event: toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95(3), p.274.. Merz, E.L., Fox, R.S. and Malcarne, V.L., 2014. Expressive writing interventions in cancer patients: a systematic review. Health Psychology Review, 8(3), pp.339–361.