Candy, B., Jones, L., Drake, R., Leurent, B., & King, M. (2011). Interventions for supporting informal caregivers of patients in the terminal phase of a disease. Cochrane Database of Systematic Reviews, 6, CD007617. 

DOI Link

Purpose

STUDY PURPOSE: To assess the effects of support interventions on the psychological and physical health of informal caregivers of patients in the terminal stage of disease

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, National Health Service Research Register, Dissertation Abstracts; a hand search of Palliative Medicine, Journal of Pain and Symptom Management, and British Journal of Psychiatry was also conducted.
 
INCLUSION CRITERIA: Evaluation of interventions that aimed to provide caregiver support in addition to usual care, including domestic or respite services, and increase coping and problem solving; psychoeducational interventions; randomized, controlled trials; adult caregivers; care recipients in advanced, terminal, or end-of-life stages
 
EXCLUSION CRITERIA: None specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 8,269
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Consumers and Communication Review Group guidelines used to assess risk of bias. Studies were generally of low quality with uncertain risk of bias in many aspects.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 11, 8 in meta-analysis
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,836
  • SAMPLE RANGE ACROSS STUDIES: 30–363
  • KEY SAMPLE CHARACTERISTICS: In eight trials, care recipients had terminal stage cancers; varied ethnic groups

Phase of Care and Clinical Applications

PHASE OF CARE: End-of-life care

APPLICATIONS: Palliative care

Results

Nine studies used interventions aimed to directly support the caregiver, and in five of these, the intervention was also aimed at the patient. In two trials, the aim was to indirectly support the caregiver via patient support. A meta-analysis of eight studies aimed at direct caregiver support to reduce psychological distress, in favor of the intervention (SMD = –0.15, 95% confidence interval [–0.28, –0.02], p = 0.02). Studies measuring improvement in coping or quality of life did not show any significant effect of the intervention. Two trials showed improved access to health services with the intervention, and one did not show any difference between groups in physical health outcomes of the caregivers.

Conclusions

Support interventions aimed directly at the caregiver reduced short-term psychological distress, with a small effect size, and resulted in marginal and insignificant improvements in coping and quality of life.

Limitations

  • Mostly low quality/high risk of bias studies
  • High heterogeneity

Nursing Implications

Supportive interventions provided directly to informal caregivers had small but significant positive effects on caregiver psychological outcomes.

Legacy ID

6447