Methods of Engaging Family Systems at End-of-life

Families are recognized in palliative and hospice care as being an integral part of end-of- life care, where they often provide informal caregiving to their terminally ill family members. Caregiving has been shown to put multiple burdens on family members and to negatively affect caregiver health, finances, and socio-emotional wellbeing. The need for end-of-life services in the United States is expected to drastically increase in the next few decades and the demands on families, friends, communities, and services around end-of-life needs will continue to increase as more people require end-of-life care. Therefore, this systematic review aimed to assess the research on nonmedical, psychosocial, family-oriented interventions used with family systems when an adult member (aged 45+) is at end of life and the effectiveness of these interventions. The family systems-illness model was used to guide this work. Eleven articles were found and assessed: Two reviews, four studies with psychoeducational interventions, and six studies with therapy-based interventions. The psychoeducational intervention studies were found to have better rigor, design, and sample sizes overall. The reviewed studies looked at various variables and found that overall the interventions had positive impacts on participants. There were findings of increased quality of life, coping, social support, hopefulness along with decreased depression, stress, reported physical symptoms of person at end of life, and negative views of caring. Attrition, standardization of measures, and inclusion of patients from other life limiting illnesses beyond cancer are all needed in further research. In addition, more studies need to be done that take into account the entire family system, and the stage and typical progression of different illnesses