Supportive interventions for family carers of patients in the terminal phase of a disease: A novel approach to synthesis on effectiveness

Context/Aims: Family and friends caring for a patient in the terminal phase of a disease may need support. Despite evaluation it is unclear what types of interventions to provide support are more appropriate. The variety of interventions trialled and how each trial has assessed benefit makes interpretation difficult. We have used a new methodological approach to categorising data in a systematic review of randomised controlled trials on the effectiveness of supportive interventions for family carers of patients in the terminal phase of a disease. Method: A Cochrane systematic review. We searched six citation databases. Key review stages were undertaken in duplicate. Our innovation was to manage variety in trials by grouping into broad categories and pool evidence. Categories were: (i) trial interventions provided either directly to the carer or indirectly (e.g. via the patient) and (ii) whether outcomes related to emotional health (i.e. psychological distress, quality of life, coping with caring), or to physical health. Results: 11 RCTs were identified. Eight evaluated direct interventions that commonly offered emotional support and aimed to improve coping skills. Three evaluated indirect interventions via patient support. In combined analyses of 5-6 trials of up to 630 participants, it was found that carers who received a direct intervention benefited more in improved emotional health than those in the control group. However, only for assessments of psychological distress was the benefit statistically significant (Standardised Mean Difference -0.19; 95% Confidence Interval -0.34, -0.03). Conclusion: Using this novel method we could pool a range of differently-reported evidence. We found that directly delivered supportive interventions may help buffer carers from psychological distress. Further research should explore in more detail areas of specific benefit to inform design of supportive interventions for carers