School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
Department of Patient Care Research, Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA.
BMJ Support Palliat Care. 2024 Jan 8;13(e3):e676-e685. doi: 10.1136/spcare-2023-004448.
Family and friend caregivers often feel overwhelmed by and ill-prepared for their responsibilities. Many feel helpless living with uncertainty about the outcome of the patient's illness, which leads to existential distress. Supportive care interventions that address existential distress by promoting meaning and purpose buffer the negative effects of caregiver burden and promote resilience and growth. The purpose of this scoping review is to describe the depth and breadth of available interventions targeting caregiver existential distress.
We followed the Joanna Briggs Institute's scoping review methods and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension checklist. SCOPUS, Ovid MEDLINE and PsycINFO databases were searched for interventions that targeted existential distress by promoting meaning-making, spiritual well-being, post-traumatic growth and/or benefit finding for caregivers of seriously ill adult patients.
We screened 1377 titles/abstracts and 42 full-text articles. Thirty-one articles (28 unique studies) met inclusion criteria. Most interventions were designed for caregivers supporting patients with cancer (n=14) or patients receiving palliative care (n=9). Promising interventions included Meaning-Centered Psychotherapy for Cancer Caregivers, Meaning-Based Intervention for Patients and their Partners, Legacy Intervention for Family Enactment, Family Participatory Dignity Therapy and Existential Behavioural Therapy. More than half of the studies (n=20, 64%) were in the feasibility/acceptability/pilot stage of intervention testing.
Large randomised controlled trials with more diverse samples of caregivers are needed. Future research should explore the impact of delivering meaning-making interventions to caregivers throughout the illness trajectory. Developing strategies for scaling up and conducting cost analyses will narrow the research and practice gap for meaning-making interventions.
家属和朋友护理人员常常感到负担过重，对自己的职责准备不足。许多人对患者病情的结果感到无助和不确定，这导致了存在性困扰。通过促进意义和目的来缓解存在性困扰的支持性护理干预措施，可以缓冲护理人员负担的负面影响，促进韧性和成长。本研究旨在描述针对护理人员存在性困扰的现有干预措施的深度和广度。
我们遵循了 Joanna Briggs 研究所的范围综述方法，并应用了系统综述和荟萃分析扩展报告的首选报告项目清单。在 SCOPUS、Ovid MEDLINE 和 PsycINFO 数据库中，搜索了通过促进意义建构、精神幸福感、创伤后成长和/或对重病成年患者的护理人员进行利益发现来针对存在性困扰的干预措施。
我们筛选了 1377 篇标题/摘要和 42 篇全文文章。31 篇文章（28 项独立研究）符合纳入标准。大多数干预措施是为支持癌症患者（n=14）或接受姑息治疗的患者（n=9）的护理人员而设计的。有前途的干预措施包括癌症护理人员的意义中心心理治疗、患者及其伴侣的意义干预、家庭实施干预、家庭参与尊严治疗和存在行为治疗。超过一半的研究（n=20，64%）处于干预测试的可行性/可接受性/试点阶段。
需要进行更大规模的随机对照试验，以纳入更多样化的护理人员样本。未来的研究应该探索在整个疾病过程中为护理人员提供意义建构干预措施的影响。制定扩大规模和进行成本分析的策略将缩小意义建构干预措施的研究和实践差距。
