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Management eBrief no. 70

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Management eBriefs
Issue 70September 2013

Effects of Caregiver Interventions on Outcomes for Memory-related Disorders or Cancer: A Systematic Review


Two recently enacted federal laws expanded VA's authority to provide a number of clinical and supportive services to families and caregivers of Veterans for service-connected and non-service-connected injuries and conditions. Investigators with the VA Evidence-based Synthesis Program conducted a review of the literature to evaluate the effects of family-involved interventions on patient outcomes for memory-related disorders or cancer. The term "family" was used to describe all those, related or non-related, who provided direct care and support to patients. Investigators reviewed 2,771 titles and abstracts published between 1980 and December 2012 and identified 59 papers representing 56 unique randomized controlled trials to answer the following four key questions.

Question #1
What are the benefits of family and caregiver psychosocial interventions for adult patients with cancer compared to usual care or wait list?

Based on 18 trials that addressed this question, results show:

  • Few studies reported statistically significant effects on any patient outcome, and non-significant effect sizes were typically small to moderate.
  • Compared to usual or standard care, family-involved interventions did not consistently improve global patient quality of life; mental, physical, or social functioning; depression/anxiety; or symptom control. (Most of the patients in these studies had prostate or breast cancer.) Studies did not report on harms to patients. However, two trials reported family outcomes that were worse for those in the family/couple intervention. The authors of these trials suggest that the negative effects were due to families becoming more aware of their own and the patient's concerns and stresses as a result of the intervention and/or the effect of discussing cancer and surgery.

Question #2
What are the benefits of one family caregiver-oriented psychosocial intervention compared to either: 1) a patient-directed intervention, or 2) another alternative family-oriented intervention in improving outcomes for adult patients with cancer?

Based on 13 trials that addressed this question, results show:

  • Investigators found either low or insufficient evidence regarding the effectiveness of family-involved interventions vs. other active controls, or alternative family or patient interventions.
  • There was insufficient evidence on the comparative effectiveness of family-involved interventions for patient physical functioning, social functioning, and global quality of life.
  • Some evidence suggests that interventions that actively involved families improved patients' general psychological functioning, depression/anxiety, and symptom control or management.
  • There were no data on patient healthcare utilization, including hospitalizations or institutionalization.
  • No studies reported harms to patients or family members.

Question #3
What are the benefits of family and caregiver psychosocial interventions for adult patients with memory-related disorders compared to usual care or wait list?

Based on 19 memory-related trials that addressed this question, results show:

  • Few studies reported statistically significant effects on any patient outcome, and the non-significant effect sizes were typically small to moderate.
  • Compared to usual care or wait list, family-involved interventions did not consistenly improve physical or cognitive functioning, hospitalizations, or institutionalization. Limited evidence suggests that targeted interventions for specific groups of patients or family members may be more effective than general interventions in managing and controlling symptoms and reducing depression.
  • No study reported poorer outcomes among family members in family or couple interventions.
  • Few studies reported patient harms.

Question #4
What are the benefits of family and caregiver psychosocial interventions compared to either: 1) a patient-directed intervention, or 2) another alternative family-oriented intervention in improving outcomes for adult patients with memory-related disorders?

Based on 14 memory-related trials that addressed this question, results show:

  • Few studies showed significant differences across patient outcomes. The evidence is not strong enough to suggest that interventions beyond providing education and minimal support to family members are more beneficial to patients.
  • There was some evidence to suggest that tailoring an intervention to fit the specific symptoms and needs of patients may be more effective than general psychosocial interventions in improving symptom control.
  • Few studies reported potential harms caused by the interventions; of those, no harms were reported to patients or family members.

Conclusions
VA has taken broad and important steps to integrate families into the care of Veterans and to support them in that role. While evidence suggests that family interventions may have positive effects on caregivers, and in patients with specific health conditions, better evidence is necessary to determine the effects of family interventions on outcomes of patients with cancer and memory-related disorders. Many studies included in this review had important methodological weaknesses that lower evidence quality. There is both limited and weak evidence to suggest that general family interventions improve outcomes for these patients. Most studies did not demonstrate patient benefits, though sub-groups of family members and patients with specific needs may benefit more than others.

Future Research
Customizing and targeting family-involved interventions to specific sub-groups may be the most efficient way to improve patient outcomes. However, before initiating widespread implementation for patients with cancer and memory-related disorders, additional evidence demonstrating effectiveness on patient outcomes is needed.

A Cyberseminar session on this ESP Report will be held on November 14, 2013 from 12:00pm to 1:15pm (ET). View archived session here.




This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers — and to disseminate these reports throughout VA.

Reference

Griffin JM, Meis L, Greer N, Jensen A, MacDonald R, Rutks I, Carlyle M, and Wilt TJ. Effectiveness of Family and Caregiver Interventions on Patient Outcomes among Adults with Cancer or Memory-Related Disorders: A Systematic Review. VA ESP Project #09-009; 2013.

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This Management eBrief is a product of the HSR&D Evidence Synthesis Program (ESP). ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.


This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of the HSR&D Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers - and to disseminate these reports throughout VA.

See all reports online.