Dharmawardene, M., Givens, J., Wachholtz, A., Makowski, S., & Tjia, J. (2015). A systematic review and meta-analysis of meditative interventions for informal caregivers and health professionals. BMJ Supportive and Palliative Care. Advance online publication.

DOI Link

Purpose

STUDY PURPOSE: To assess meditative intervention outcomes on physical and emotional markers of well-being, job satisfaction, and burnout among informal caregivers (ICG) and health professionals
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PubMed, EMBASE, CINAHL, and PsycINFO
 
KEYWORDS: Article text key words combined with medical subject heading (MeSH) terms for all assessed databases
 
INCLUSION CRITERIA: Studies used a form of meditation intervention defined by the study and included mantra meditation and mindfulness meditation defined by the Agency for Healthcare Research and Quality; studies with a randomized, controlled trial design or a pre/post assessment of the intervention; studies focused on health professional caregivers or ICGs
 
EXCLUSION CRITERIA: Studies involving movement-based practices such as yoga asana, tai chi or qigong; studies defined as dissertations, poster or conference presentations, or letters to the editor; studies in languages other than English; studies containing fewer than five participants or reporting on healthcare employees in general but not specifically on healthcare providers with direct patient care responsibilities; studies involving multicomponent interventions not separately reporting the effects of any meditative components

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 2,912
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The authors used a consistent scoring process to assess study quality (criteria of Downs and Black) and factors potentially affecting bias (i.e., blinding, recruitment, randomization, analytic approach). A similar process was used to construct a meta-analysis of the two different groups assessed (ICGs and healthcare providers) and the negative and positive outcome domains of each group (e.g., depression, anxiety, fatigue, hope, satisfaction). The authors appropriately used the Q statistic and comprehensive meta-analysis (analysis package) to appropriately assess heterogeneity of effect estimates and random-effects models to predict mean differences for each outcome when included studies had sufficient information to do so.  

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 27; n = 15 focused on ICGs (seven randomized, controlled trials, one nonrandomized controlled trial, and seven pre/postintervention studies)
 
TOTAL PATIENTS INCLUDED IN REVIEW: 9-78; majority are female ICG.  Studies median quality score (based on Downs and Black) was 11, range typically 7-17
 
SAMPLE RANGE ACROSS STUDIES: 
 
KEY SAMPLE CHARACTERISTICS: The majority of studies involved the ICGs of patients with dementia; only one study involved ICGs of patients with cancer.

Phase of Care and Clinical Applications

PHASE OF CARE: End of life care, various stages of diseases (dementia, advanced disease including cancer, children chronic illness) care  
 
APPLICATIONS: Pediatrics, Elder care, Palliative care

Results

  • Reported only on the arm that involved informal caregivers
  • Eight of 15 ICG studies provided self-reported data on stress and anxiety. Seven of the 15 studies reported statistically significant improvements with informal caregiver use of meditative interventions. 
  • Twelve of 15 studies measured ICGs' mood or mental health. Eight of those reported statistically significant improvements in caregiver mental health after a mindfulness intervention.
  • Heterogeneity Q statistics were statistically significant for controlled trials of anxiety and for pre- and postintervention studies of ICG depression. 
  • The combined effect for controlled trial studies involving ICGs on depression, anxiety, stress, self-reported efficacy, and quality of life and mental health showed benefits from meditation. 
  • The combined effect for pre- and postintervention studies on depression, anxiety, stress, and caregiver burden showed meditation benefits.
  • An insufficient number of studies existed to examine combined effect for caregiver fatigue, sleep quality, confusion and grief, personal growth, hope, energy, and life satisfaction was included.  
  • Three out of the six studies that examined self-efficacy (a positive outcome) showed significant caregiver improvement, but the combined effect of the controlled trials suggested a meditation benefit but not for a reduction of caregiver burden. 
  • Six of the seven studies of ICGs that assessed physiological measures of stress showed a statistically significant change postintervention. 

Conclusions

Focusing on the outcomes for ICGs, the combined evidence from the controlled trials supports use of meditative interventions to minimize ICG’s depression, anxiety, and stress. Combined evidence from the pre- and postmeditative intervention studies supported their use in alleviating ICG burden. However, the insufficient study rigor and number prevent ed conclusions about the meditative interventions' effects on caregiver energy, fatigue, hope, confusion, and grief or life satisfaction. The insufficient number of studies prevents assessment of effect of meditation on caregivers’ capacity for decision making, patient advocacy, or resilience.

Limitations

  • Review of the ICGs of mostly patients without cancer limits the applicability for patients with cancer and their caregivers  
  • Insufficient studies exist to make conclusions about several caregiver-related outcomes (e.g., energy, fatigue, hope, confusion, grief or life satisfaction, capacity for decision making, patient advocacy or resilience).
  • The majority of female study participants minimized the generalizability of findings to male ICGs.
  • Many studies relied on self-report with a wide variability of assessed study qualities (Downs and Black criteria).
  • Study reviewed only English language studies

Nursing Implications

The effect of a meditative intervention on caregivers of patients with cancer should be explored with more studies using rigorous designs possessing higher statistical power. The initial data from this study indicate that a meditative intervention may benefit the ICGs of patients with various illnesses.

Legacy ID

5208