Dataset Information

Effectiveness of family and caregiver interventions on patient outcomes in adults with cancer: a systematic review.

ABSTRACT:

Background

Family and caregiver interventions typically aim to develop family members' coping and caregiving skills and to reduce caregiver burden. We conducted a systematic review of published randomized controlled trials (RCTs) evaluating whether family-involved interventions improve patient outcomes among adults with cancer.

Methods

RCTs enrolling patients with cancer were identified by searching MEDLINE, PsycInfo and other sources through December 2012. Studies were limited to subjects over 18 years of age, published in English language, and conducted in the United States. Patient outcomes included global quality of life; physical, general psychological and social functioning; depression/anxiety; symptom control and management; health care utilization; and relationship adjustment.

Results

We identified 27 unique trials, of which 18 compared a family intervention to usual care or wait list (i.e., usual care with promise of intervention at completion of study period) and 13 compared one family intervention to another individual or family intervention (active control). Compared to usual care, overall strength of evidence for family interventions was low. The available data indicated that overall, family-involved interventions did not consistently improve outcomes of interest. Similarly, with low or insufficient evidence, family-involved interventions were not superior to active controls at improving cancer patient outcomes.

Discussion

Overall, there was low or insufficient evidence that family and caregiver interventions were superior to usual or active care. Variability in study populations and interventions made pooling of data problematic and generalizing findings from any single study difficult. Most of the included trials were of poor or fair quality.

SUBMITTER: Griffin JM

PROVIDER: S-EPMC4139519 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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Publications

Effectiveness of family and caregiver interventions on patient outcomes in adults with cancer: a systematic review.

Griffin Joan M JM Meis Laura A LA MacDonald Roderick R Greer Nancy N Jensen Agnes A Rutks Indulis I Wilt Timothy J TJ

Journal of general internal medicine 20140520 9

<h4>Background</h4>Family and caregiver interventions typically aim to develop family members' coping and caregiving skills and to reduce caregiver burden. We conducted a systematic review of published randomized controlled trials (RCTs) evaluating whether family-involved interventions improve patient outcomes among adults with cancer.<h4>Methods</h4>RCTs enrolling patients with cancer were identified by searching MEDLINE, PsycInfo and other sources through December 2012. Studies were limited to ...[more]

PMID: 24841557

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Project description:ObjectiveTo synthesize the evidence examining caregiver-mediated mobility interventions in a hospital setting and whether they improve patient, caregiver, or health system outcomes.Data sourcesWe searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from inception to September 7, 2018.Study selectionTwo reviewers independently selected original research in inpatient settings that reported on an intervention delivered by a caregiver (eg, family, friend, paid worker) and directed to the patient's mobility. Mobility interventions were categorized based on the level of caregiver engagement using a 3-category framework: inform (provision of education on patient's condition and management), activate (prompting caregivers to take action in patient care), and collaborate (encouraging interaction with providers or other caregivers).Data extractionOne reviewer extracted data, and another checked the data. Quality was assessed using the Cochrane Collaboration's risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluation approach.Data synthesisForty studies met the inclusion criteria; most were randomized controlled trials (n=16/40, 40.0%) and investigated older adults (n=18/40, 45.0%) with stroke (n=20/40, 50.0%). Inform (n=2) and activate (n=4) interventions and combined inform-activate (n=5/6, 83.3%) and inform-activate-collaborate (n=6/10, 60.0%) interventions were reported to improve patient mobility. Inform-activate and inform-collaborate interventions were reported to improve caregiver outcomes (eg, burden) (n=13/19, 68.4%). Studies that engaged caregivers in all 3 strategies (inform-activate-collaborate) were reported to improve health system outcomes (eg, hospital readmission) (n=4/6, 66.7%). Most studies were of unclear (n=22/40, 55.0%) or low risk of bias (n=11/40, 27.5%) for most domains.ConclusionsEngaging caregivers in mobility of hospitalized patients may improve patient mobility as well as caregiver and health system outcomes.

Project description:BackgroundCaregivers may promote the uptake of science into patient care and the practice of evidence-informed medicine. The purpose of this study was to determine whether caregiver-mediated (non-clinical caregiver-delivered) interventions are effective in improving patient, caregiver, provider, or health system outcomes.MethodsWe searched the MEDLINE, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health, and Scopus databases from inception to February 27, 2017. Interventions (with a comparison group) reporting on a quality improvement intervention mediated by a caregiver and directed to a patient, in all ages and patient-care settings, were selected for inclusion. A three-category framework was developed to characterize caregiver-mediated interventions: inform (e.g., provide knowledge), activate (e.g., prompt action), and collaborate (e.g., lead to interaction between caregivers and other groups [e.g., care providers]).ResultsFifty-six studies met the inclusion criteria, and 64% were randomized controlled trials (RCTs). The most commonly assessed outcomes were patient- (n?=?40) and caregiver-oriented (n?=?33); few health system- (n?=?10) and provider-oriented (n?=?2) outcomes were reported. Patient outcomes (e.g., satisfaction) were most improved by caregiver-mediated interventions that provided condition and treatment education (e.g., symptom management information) and practical condition-management support (e.g., practicing medication protocol). Caregiver outcomes (e.g., stress-related/psychiatric outcomes) were most improved by interventions that activated caregiver roles (e.g., monitoring blood glucose) and provided information related to that action (e.g., why and how to monitor). The risk of bias was generally high, and the overall quality of the evidence was low-moderate, based on Grading of Recommendations Assessment Development and Evaluation ratings.ConclusionsThere is a large body of research, including many RCTs, to support the use of caregiver-mediated interventions that inform and activate caregivers to improve patient and caregiver outcomes. Select caregiver-mediated interventions improve patient (inform-activate) and caregiver (inform-activate-collaborate) outcomes and should be considered by all researchers implementing patient- and family-oriented research.Systematic reviewPROSPERO, CRD42016052509 .

Project description:BackgroundPatient-ventilator asynchrony (PVA) is a common problem in patients undergoing invasive mechanical ventilation (MV) in the intensive care unit (ICU), and may accelerate lung injury and diaphragm mis-contraction. The impact of PVA on clinical outcomes has not been systematically evaluated. Effective interventions (except for closed-loop ventilation) for reducing PVA are not well established.MethodsWe performed a systematic review and meta-analysis to investigate the impact of PVA on clinical outcomes in patients undergoing MV (Part A) and the effectiveness of interventions for patients undergoing MV except for closed-loop ventilation (Part B). We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, ClinicalTrials.gov, and WHO-ICTRP until August 2020. In Part A, we defined asynchrony index (AI) ≥ 10 or ineffective triggering index (ITI) ≥ 10 as high PVA. We compared patients having high PVA with those having low PVA.ResultsEight studies in Part A and eight trials in Part B fulfilled the eligibility criteria. In Part A, five studies were related to the AI and three studies were related to the ITI. High PVA may be associated with longer duration of mechanical ventilation (mean difference, 5.16 days; 95% confidence interval [CI], 2.38 to 7.94; n = 8; certainty of evidence [CoE], low), higher ICU mortality (odds ratio [OR], 2.73; 95% CI 1.76 to 4.24; n = 6; CoE, low), and higher hospital mortality (OR, 1.94; 95% CI 1.14 to 3.30; n = 5; CoE, low). In Part B, interventions involving MV mode, tidal volume, and pressure-support level were associated with reduced PVA. Sedation protocol, sedation depth, and sedation with dexmedetomidine rather than propofol were also associated with reduced PVA.ConclusionsPVA may be associated with longer MV duration, higher ICU mortality, and higher hospital mortality. Physicians may consider monitoring PVA and adjusting ventilator settings and sedatives to reduce PVA. Further studies with adjustment for confounding factors are warranted to determine the impact of PVA on clinical outcomes. Trial registration protocols.io (URL: https://www.protocols.io/view/the-impact-of-patient-ventilator-asynchrony-in-adu-bsqtndwn , 08/27/2020).

Project description:ImportancePhysicians often rely on surrogate decision-makers (SDMs) to make important decisions on behalf of critically ill patients during times of incapacity. It is uncertain whether targeted interventions to improve surrogate decision-making in the intensive care unit (ICU) reduce nonbeneficial treatment and improve SDM comprehension, satisfaction, and psychological morbidity.ObjectiveTo perform a systematic review and meta-analysis of randomized clinical trials (RCTs) to determine the association of such interventions with patient- and family-centered outcomes and resource use.Data sourcesA search was conducted of MEDLINE, Embase, and other relevant databases for potentially relevant studies from inception through May 30, 2018.Study selectionRandomized clinical trials studying interventions that were targeted at SDMs or family members of critically ill adults in the ICU were included. Key search terms included surrogate or substitute decision-maker, critically ill, randomized controlled trials, and their respective related terms.Data extraction and synthesisThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent, blinded reviewers independently screened citations and extracted data. Random effects models with inverse variance weighting were used to pool outcomes data when possible and otherwise present findings qualitatively.Main outcomes and measuresOutcomes of interest were divided into 3 categories: (1) patient-related clinical outcomes (mortality, length of stay [LOS], duration of life-sustaining therapies), (2) SDM and family-related outcomes (comprehension, major change in goals of care, incident psychological comorbidities [posttraumatic stress disorder, anxiety, depression], and satisfaction with care), and (3) use of resources (cost of care and health care resource use).ResultsOf 3735 studies screened, 13 RCTs were included, comprising a total of 10 453 patients. Interventions were categorized as health care professional led (n = 6), ethics consultation (n = 3), palliative care consultation (n = 2), and media (n = 1 pamphlet and 1 video). No association with mortality was observed (risk ratio, 1.03; 95% CI, 0.98-1.08; P = .22). Intensive care unit LOS was significantly shorter among patients who died (mean difference, -2.11 days; 95% CI, -4.16 to -0.07; P = .04), but not in the overall population (mean difference, -0.79 days; 95% CI, -2.33 to 0.76 days; P = .32). There was no consistent difference in SDM-related outcomes, including satisfaction with care or perceived quality of care (n = 6 studies) and incident psychological comorbidities (depression: ratio of means, -0.11; 95% CI, -0.29 to 0.08; P = .26; anxiety: ratio of means, -0.08; 95% CI, -0.25 to 0.08; P = .31; or posttraumatic stress disorder: ratio of means: -0.04; 95% CI, -0.21 to 0.13; P = .65). Among 6 trials reporting effects on health care resource use, only 1 nurse-led intervention observed a significant reduction in costs ($75 850 control vs $51 060 intervention; P = .04).Conclusions and relevanceSystematic interventions aimed at improving surrogate decision-making for critically ill adults may reduce ICU LOS among patients who die in the ICU, without influencing overall mortality. Better understanding of the complex processes related to surrogate decision-making is needed.

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Project description:BACKGROUND:Supporting women to initiate and continue breastfeeding is a global challenge. A range of breastfeeding interventions employing electronic technologies (e-technologies) are being developed, which offer different delivery modes and features over the internet; however, the impact of internet-based e-technologies on breastfeeding outcomes remains unclear. OBJECTIVE:This study aimed to identify the characteristics of current internet-based breastfeeding interventions employing e-technologies and investigate the effects of internet-based e-technologies on breastfeeding outcomes. METHODS:A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the following databases: Scopus, Web of Science, the Cochrane Database of Systematic Reviews, ScienceDirect, Google Scholar, the Association for Computing Machinery, SpringerLink, and Institute of Electrical and Electronics Engineers Xplore. RESULTS:This systematic review included 16 studies published between 2007 and 2018, with 4018 women in 8 countries. The characteristics of the interventions were grouped based on (1) mode of delivery (web-based, mobile phone apps, and computer kiosk), (2) purpose of the interventions (education and support), and (3) key strategies (monitoring and breastfeeding tracking, personalization, online discussion forum, web-based consultation, and breastfeeding station locators). Combining educational activities with web-based personalized support through discussion forums appeared to be the most effective way to improve breastfeeding outcomes and long-term exclusive breastfeeding rates. Monitoring and breastfeeding trackers appeared to be the least effective ways. CONCLUSIONS:This study demonstrated a variety of internet-based e-technologies that professionals can use to promote, educate, and support breastfeeding women. Future internet-based breastfeeding interventions employing e-technologies might consider improving interaction with mothers and personalizing the content of the proposed interventions.

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Dataset Information

Effectiveness of family and caregiver interventions on patient outcomes in adults with cancer: a systematic review.

Background

Methods

Results

Discussion

Publications

Effectiveness of family and caregiver interventions on patient outcomes in adults with cancer: a systematic review.

Similar Datasets

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