Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, P.R. China.
Outpatient Department, West China Hospital, Sichuan University, P.R. China.
Int J Nurs Stud. 2024 Dec;160:104895. doi: 10.1016/j.ijnurstu.2024.104895. Epub 2024 Sep 6.
To investigate the efficacy of targeted palliative care interventions on depression, quality of life and caregiver burden in informal caregivers of advanced cancer patients, along with the consequences of various intervention types.
This study performed a comprehensive review and a meta-analysis of randomized controlled trials.
An extensive search was carried out across eight databases, namely, PubMed, Embase, CLNAHL, PsyclNFO, Cochrane, VIP, CNKI, and WANFANG, spanning from the inception of the library to May 4, 2024. Two examiners independently screened the articles and extracted the data according to the eligibility criteria formulated in accordance with the PICOS principles. The meta-analysis was conducted utilizing the StataCorp (version 16.0), estimating the impacts of the interventions through the computation of the standardized mean difference (SMD) and the 95 % confidence interval (CI). Sensitivity analysis was carried out using a one-way-out method. Egger's test and the Duval and Tweedie trim-and-fill methods were used to explore the potential publication bias. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of the included studies, and the overall quality of evidence was evaluated using the GRADE method.
This study pooled 16 RCTs (including 2046 informal caregivers) that were published from 2007 to 2023. The meta-analysis results indicated that the targeted palliative care interventions significantly improved depression (SMD = -0.74, 95 % CI: [-1.25, -0.23], P < 0.01) and quality of life (SMD = 0.63, 95 % CI: [0.08, 1.17], P = 0.03), though not in terms of caregiver burden (SMD = -0.33, 95 % CI: [-0.95, 0.29], P = 0.30) among informal caregivers of advanced cancer patients. Analysis of the subgroups revealed a correlation between short-term interventions, under three months, and the improvement of depression. Strategies focused solely on caregivers have proven effective in alleviating depression. Interventions utilizing offline methods have been shown to not only lower depression levels but also improve the quality of life for caregivers.
The targeted palliative care interventions effectively improved informal caregivers' depression and quality of life, yet they fail to markedly lessen the caregiver burden. To better support informal caregivers, interveners ought to adopt personalized strategies based on comprehensive consideration of the duration, format, and delivery methods of the interventions. Simultaneously, further exploration and effort from scholars are necessary to enhance the accessibility of palliative care services, and to effectively incorporate academic research findings into clinical practice.
CRD42023475620.
探讨针对晚期癌症患者的非正式照护者的姑息治疗干预措施在抑郁、生活质量和照护者负担方面的疗效，以及各种干预类型的后果。
本研究对随机对照试验进行了全面综述和荟萃分析。
在 8 个数据库（PubMed、Embase、CLNAHL、PsyclNFO、Cochrane、VIP、CNKI 和 WANFANG）中进行了广泛的搜索，时间范围从图书馆建立到 2024 年 5 月 4 日。两名审查员根据按照 PICOS 原则制定的入选标准，独立筛选文章并提取数据。使用 StataCorp（版本 16.0）进行荟萃分析，通过计算标准化均数差（SMD）和 95%置信区间（CI）来估计干预措施的影响。使用单向剔除法进行敏感性分析。使用 Egger 检验和 Duval 和 Tweedie 修剪和填充方法来探索潜在的发表偏倚。使用 Cochrane 偏倚风险工具评估纳入研究的方法学质量，并使用 GRADE 方法评估证据的总体质量。
本研究纳入了 2007 年至 2023 年发表的 16 项 RCT（包括 2046 名非正式照护者）。荟萃分析结果表明，针对姑息治疗的干预措施显著改善了晚期癌症患者非正式照护者的抑郁（SMD=-0.74，95%CI：[-1.25，-0.23]，P<0.01）和生活质量（SMD=0.63，95%CI：[0.08，1.17]，P=0.03），但对照护者负担（SMD=-0.33，95%CI：[-0.95，0.29]，P=0.30）没有影响。亚组分析显示，短期干预（三个月以下）与抑郁改善有关。仅针对照护者的策略已被证明可有效缓解抑郁。使用离线方法的干预措施不仅降低了抑郁水平，还提高了照护者的生活质量。
针对姑息治疗的干预措施可有效改善非正式照护者的抑郁和生活质量，但不能显著减轻照护者的负担。为了更好地支持非正式照护者，干预者应根据干预措施的持续时间、形式和提供方式，采用个性化策略。同时，学者们需要进一步探索和努力，以提高姑息治疗服务的可及性，并将学术研究成果有效纳入临床实践。
CRD42023475620。
