1 Research Fellow, Centre for Reviews and Dissemination, University of York, UK.
2 Information Specialist, Centre for Reviews and Dissemination, University of York, UK.
J Health Serv Res Policy. 2018 Jul;23(3):196-207. doi: 10.1177/1355819618766559. Epub 2018 May 16.
Objective To update a 2010 meta-review of systematic reviews of effective interventions to support carers of ill, disabled, or older adults. In this article, we report the most promising interventions based on the best available evidence. Methods Rapid meta-review of systematic reviews published from January 2009 to 2016. Results Sixty-one systematic reviews were included (27 high quality, 25 medium quality, and nine low quality). The quality of reviews has improved since the original review, but primary studies remain limited in quality and quantity. Fourteen high quality reviews focused on carers of people with dementia, four on carers of those with cancer, four on carers of people with stroke, three on carers of those at the end of life with various conditions, and two on carers of people with mental health problems. Multicomponent interventions featured prominently, emphasizing psychosocial or psychoeducational content, education and training. Improved outcomes for carers were reported for mental health, burden and stress, and wellbeing or quality of life. Negative effects were reported in reviews of respite care. As with earlier work, we found little robust evidence on the cost-effectiveness of reviewed interventions. Conclusions There is no 'one size fits all' intervention to support carers. There is potential for effective support in specific groups of carers, such as shared learning, cognitive reframing, meditation, and computer-delivered psychosocial support for carers of people with dementia. For carers of people with cancer, effective support may include psychosocial interventions, art therapy, and counselling. Carers of people with stroke may also benefit from counselling. More good quality, theory-based, primary research is needed.
目的 更新 2010 年对支持病、残、老年患者照顾者的有效干预措施的系统评价元分析。本文根据现有最佳证据，报告最有前景的干预措施。
方法 对 2009 年 1 月至 2016 年发表的系统评价进行快速元分析。
结果 共纳入 61 篇系统评价（27 篇高质量、25 篇中质量、9 篇低质量）。与原始综述相比，综述质量有所提高，但原始研究的质量和数量仍有限。14 篇高质量综述聚焦于痴呆患者照顾者，4 篇聚焦于癌症患者照顾者，4 篇聚焦于脑卒中患者照顾者，3 篇聚焦于各种疾病终末期患者照顾者，2 篇聚焦于精神健康问题患者照顾者。多组分干预措施较为突出，强调心理社会或心理教育内容、教育和培训。照顾者的心理健康、负担和压力以及幸福感或生活质量得到改善。暂息护理的综述报告了负面结果。与早期工作一样，我们发现关于已审查干预措施的成本效益的稳健证据很少。
结论 没有一种“一刀切”的干预措施可以支持所有照顾者。在特定照顾者群体中，如共享学习、认知重构、冥想和针对痴呆患者照顾者的计算机提供的心理社会支持，可能存在有效的支持。对于癌症患者的照顾者，有效的支持可能包括心理社会干预、艺术治疗和咨询。脑卒中患者的照顾者也可能从咨询中受益。需要更多高质量、基于理论的原始研究。
