A randomized clinical trial assessing a pragmatic intervention to improve supportive care for family caregivers of patients with lung cancer

Informal Caregiver Burden in Palliative Care and the Role of the Family Doctor: A Scoping Review

Background/Objectives: Caregivers play a central role in supporting patients in palliative care but often face significant challenges to their physical, emotional, social, and financial well-being. Family doctors are uniquely positioned to help alleviate this burden through early identification, targeted interventions, and coordinated care. This scoping review analyzed existing literature on caregiver burden in palliative care to explore the specific role of family doctors in identifying, preventing, and reducing this burden. Methods: A scoping review was carried out following the methodology set out by the Joanna Briggs Institute. The following databases were searched: PubMed, the Cochrane Library, Scopus, the National Institute for Health and Care Excellence, and the British Medical Journal. The search strategy was based on the use of the following keywords and Medical Subject Headings: "caregiver burden" AND "palliative care" AND ("family physician" OR "general practitioners" OR "primary care physicians"). The search was performed on 10 March 2024, with a time horizon between 2013 and 2023. Results: From 259 identified articles, 8 met the inclusion criteria. Key themes included factors influencing caregiver burden, strategies used by family doctors to mitigate it, and challenges in providing support. Family doctors play a crucial role in offering psychological support, educating caregivers on disease progression, and coordinating multidisciplinary care. Conclusions: The active involvement of family doctors significantly reduces caregiver burden by addressing emotional distress, improving communication, and ensuring care coordination. Key interventions include early distress screening, tailored education, and access to multidisciplinary networks. Strengthening their integration in palliative care teams is essential for optimizing patient and caregiver outcomes.

Impact of Caregiver and Patient Age on Efficacy of Caregiver Interventions in Advanced Cancer: A Meta-Regression

INTRODUCTION

It has been shown that interventions to support caregivers of patients with advanced cancer improve caregiver wellbeing, but the possible additional influence of patient and caregiver age is unknown. We measured the impact of patient and caregiver age on the efficacy of caregiver interventions.

METHODS

We included all studies from a recent meta-analysis of randomized controlled trials of caregiver support interventions for adult caregivers of adults with advanced cancer that reported on outcomes of quality of life (QOL), anxiety, or depression. Random-effects meta regression was performed on each outcome for continuous variables of: 1) mean patient age, 2) mean caregiver age, and 3) mean age difference between mean age of patients and caregivers. Among study sets demonstrating statistically significant associations, we performed sensitivity analyses excluding influential outliers.

RESULTS

Twenty-four studies reporting on 23 trials involving 3306 caregivers were included in this meta-regression. Interventions were associated with improved QOL, anxiety and depression. In studies with older mean patient age, interventions had a greater impact on QOL (P = 0.04). In studies with younger mean caregiver age, interventions had a greater impact on depression (P = 0.02). In studies with a larger patient-caregiver age difference, interventions had a greater impact on anxiety (P = 0.01), but this effect did not prevail on sensitivity analysis (P = 0.52).

CONCLUSION

Age of patients with advanced cancer and their caregivers may influence the efficacy of caregiver support interventions, and should be taken into account when designing these interventions and interpreting their effect.

Effects of a perioperative support program on reducing psychological distress for family caregivers of patients with early-stage lung cancer: a pilot randomised controlled trial

BACKGROUND

For family caregivers, lung cancer surgery is an episodic and stressful event. Some family caregivers frequently lack the necessary skills for their roles, and they may experience psychological distress, which reduce their own quality of life whilst affecting the health outcomes of patients. However, research on perioperative support programs that focus on caregivers of patients with early-stage lung cancer is limited. Thus, this study aimed to assess the feasibility, acceptability and preliminary efficacy of a perioperative support program for family caregivers of patients with early-stage lung cancer.

METHODS

A single-blinded, parallel-group, pilot randomised controlled trial was conducted. Seventy family caregivers of patients with stage I or II lung cancer were recruited from March to May 2022 in the thoracic surgery department of a university-affiliated hospital in Changsha, China. The participants were randomised into the intervention group (n = 35) or control group (n = 35). The intervention consisted of four face-to-face intervention sessions during the hospital stay and two weekly telephone follow-up sessions after discharge, which aimed to improve caregivers' perioperative care knowledge and coping skills to reduce psychological distress and caregiver burden and to improve their quality of life. Feasibility was assessed by the rates of recruitment, attrition, time spent on completing the questionnaire and the duration of each session. Acceptability was evaluated using the Client Satisfaction Questionnaire. Preliminary intervention effects were evaluated on primary (psychological distress) and secondary (caregiver burden, quality of life, coping style and social support) outcomes.

RESULTS

The feasibility of the program was established at a high recruitment rate of 89.7% and a low attrition rate of 10.0%. The participants were highly satisfied with the program. Although the psychological distress was reduced in the intervention group, the results were not statistically significant (P = 0.106, Cohen's d = - 0.28). No significant differences in caregiver burden, active coping, negative coping, social support and quality of life (P > 0.05 for all) were found between the two groups at 4 weeks after the intervention.

CONCLUSIONS

The perioperative support program may be feasible and acceptable for family caregivers of patients with early-stage lung cancer. The program provides caregivers with coping and communication skill training and psychoeducational strategies to help them face the perioperative challenges of caring for patients with early-stage lung cancer. Based on the promising results of this pilot study, we have conducted a large-scale randomised controlled trial to evaluate the intervention's effectiveness.

TRIAL REGISTRATION

This study was retrospectively registered at the Chinese Clinical Trial Registry. Registration Date: February 25, 2022.

REGISTRATION NUMBER

ChiCTR2200056965.

Nursing Support for Caregiver Burden in Family Caregivers of Patients With Cancer: A Scoping Review

Purpose: To identify nursing support for caregiver burden in family caregivers of patients with cancer. Methods: This scoping review was guided by Arksey and O'Malley's six-stage scoping review framework. All available published articles from database inception to July 31, 2023 were systematically searched through PubMed, CINAHL, CENTRAL, and Ichushi-Web of the Japan Medical Abstract Society databases with additional relevant studies from the article list. Each key journal was manually searched. Results: Overall, 502 articles were screened, and 34 were finally included. The results of the qualitative thematic analysis were categorized into 7 components of nursing support: psychological and educational support, psychological and educational support using mainly non-face-to-face (Information and Communication Technology), psychological and educational support mainly using non-face-to-face (telephone) methods, mindfulness to support, support aimed at reducing caregiver stress, support for both patients and caregivers, and others. Of the 34 studies, 23 were randomized controlled trials (RCT), and the remaining 11 were non-RCTs. Conclusion: The results of the scoping review categorized nursing support for caregiver burden in the family caregivers of patients with cancer into 7 components. Future research should examine the feasibility of implementing these components.

From patient-reported outcomes (PROs) to family-reported outcomes (FROs): Acceptability and perceived usefulness of routine screening in cancer care

OBJECTIVES

To explore the acceptability of screening for family-reported outcomes (FROs) among cancer caregivers (unpaid family members or friends who provide support to patients with cancer) and identify from their perspective the key components of a FRO screening program.

METHODS

Using a qualitative descriptive design, semi-structured interviews were undertaken with 23 adult caregivers of people with cancer between 2020 and 2021. Interview questions focused on acceptability of FRO screening, types of FROs, timing/frequency of screening, preferred resources following screening, and communication of FROs to patients and clinicians. Participants were recruited in Canada. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis and constant comparison.

RESULTS

Almost all caregivers welcomed FRO screening in usual care and viewed it as an avenue toward obtaining more resources. Other potential benefits of FRO screening included increased self-reflection and role acknowledgment. Caregivers prioritized screening for emotional symptoms, and most preferred that the results be shared with the patient's treating team rather than their primary care provider. Caregivers did not want results to be shared with patients, instead favoring learning how best to discuss results with patients. Many spoke of a "one stop shop" containing all relevant information on caring for the patient (first) and for themselves (second). Opinions regarding timing and frequency of FRO screening differed. Periodic administration of FRO measures, with each one not exceeding 20 minutes, was deemed appropriate.

SIGNIFICANCE OF RESULTS

This study extends the concept of patient-reported outcome measures to caregivers, and findings can be used to guide the development of FRO screening programs.

Palliative Care for Patients With Cancer: ASCO Guideline Update

PURPOSE

To provide evidence-based guidance to oncology clinicians, patients, nonprofessional caregivers, and palliative care clinicians to update the 2016 ASCO guideline on the integration of palliative care into standard oncology for all patients diagnosed with cancer.

METHODS

ASCO convened an Expert Panel of medical, radiation, hematology-oncology, oncology nursing, palliative care, social work, ethics, advocacy, and psycho-oncology experts. The Panel conducted a literature search, including systematic reviews, meta-analyses, and randomized controlled trials published from 2015-2023. Outcomes of interest included quality of life (QOL), patient satisfaction, physical and psychological symptoms, survival, and caregiver burden. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 52 relevant studies to inform the evidence base for this guideline.

RECOMMENDATIONS

Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions. Oncology clinicians from across the interdisciplinary cancer care team may refer the caregivers (eg, family, chosen family, and friends) of patients with cancer to palliative care teams for additional support. The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care.Additional information is available at www.asco.org/supportive-care-guidelines.

Echoes of Support: A Qualitative Meta-Synthesis of Caregiver Narratives in Lung Cancer Care

Lung cancer stands as one of the prevalent cancers, impacting both men and women globally. Family caregivers, deeply involved in the care of individuals affected by this disease, often endure heightened distress and struggle to navigate the manifold challenges associated with caregiving. Understanding the intricate experiences and challenges of caregivers in the realm of lung cancer care is critical, given its profound impact on their well-being and the quality of patient care. This study aimed to comprehensively examine and synthesize qualitative data concerning caregiver experiences within the context of lung cancer. Six databases were systematically searched for studies with qualitative findings relevant to caregivers and lung cancer. Seventeen studies were included, and findings were reviewed and synthesized. The main challenges identified were: 'Information accessibility', 'Dual roles and family dynamics', 'Coping with emotional challenges and uncertainty', and 'Need for support networks'. These findings underscore the profound challenges faced by caregivers, shedding light on the substantial impact of cancer on their well-being and functionality. Moreover, the study accentuates the pressing need for tailored support systems that can address the emotional toll and information needs of caregivers. This emphasis on supportive interventions is vital to enhance the quality of care and overall well-being for both patients and caregivers within the lung cancer care continuum.

Systematic review and meta-analysis of randomized controlled trials of interventions addressing caregiver distress and burden among cancer caregivers

Objective

Informal caregivers (ICs) are vital to supportive cancer care and assisting cancer patients, but this caregiving burden is associated with significant distress. While addressing caregiving, it is important to explore if the caregivers are receiving care they need. Evaluating interventions that address burden and distress is integral to targeting ICs needs. This study evaluated interventions addressing IC burden and distress.

Methods

Randomized control trials (RCT) assessing interventions for IC burden and distress and exploring supportive care as an adjunct to the intervention were included. Six electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through October 2021. Effect sizes were estimated, and risk of bias was assessed.

Results

Of 678 studies, 11 were included. Most ICs were spouses, females, and white. Interventions included educational programs, cognitive behavioral treatment, and a telephone support program. Five studies utilized behavioral theories and seven included supportive care. Pooled results showed no significant effect on reducing caregiver distress (ES, -0.26, p<0.001).

Conclusions

Caring for the caregiver with interventions for reducing burden and distress are not efficacious. Innovative, well-designed, more pragmatic RCTs are needed.

Innovation

This study exclusively focused on interventions and supportive care needs for reducing distress and burden among cancer ICs.

Interventions to improve outcomes for caregivers of patients with advanced cancer: a meta-analysis

BACKGROUND

Family caregivers of patients with advanced cancer often have poor quality of life (QOL) and mental health. We examined the effectiveness of interventions offering support for caregivers of patients with advanced cancer on caregiver QOL and mental health outcomes.

METHODS

We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and Cumulative Index to Nursing and Allied Health Literature databases from inception through June 2021. Eligible studies reported on randomized controlled trials for adult caregivers of adult patients with advanced cancer. Meta-analysis was conducted for primary outcomes of QOL, physical well-being, mental well-being, anxiety, and depression, from baseline to follow-up of 1-3 months; secondary endpoints were these outcomes at 4-6 months and additional caregiver burden, self-efficacy, family functioning, and bereavement outcomes. Random effects models were used to generate summary standardized mean differences (SMD).

RESULTS

Of 12 193 references identified, 56 articles reporting on 49 trials involving 8554 caregivers were eligible for analysis; 16 (33%) targeted caregivers, 19 (39%) patient-caregiver dyads, and 14 (29%) patients and their families. At 1- to 3-month follow-up, interventions had a statistically significant effect on overall QOL (SMD = 0.24, 95% confidence interval [CI] = 0.10 to 0.39); I2 = 52.0%), mental well-being (SMD = 0.14, 95% CI = 0.02 to 0.25; I2 = 0.0%), anxiety (SMD = 0.27, 95% CI = 0.06 to 0.49; I2 = 74.0%), and depression (SMD = 0.34, 95% CI = 0.16 to 0.52; I2 = 64.4) compared with standard care. In narrative synthesis, interventions demonstrated improvements in caregiver self-efficacy and grief.

CONCLUSIONS

Interventions targeting caregivers, dyads, or patients and families led to improvements in caregiver QOL and mental health. These data support the routine provision of interventions to improve well-being in caregivers of patients with advanced cancer.

Impact of early palliative care on the quality of life in caregivers of cancer patients: A systematic review

BACKGROUND

Maintaining caregivers' quality of life (QoL) is critical to sustaining the care needed for cancer patients. One of the interventions applied to cancer patients' caregivers is early palliative care (EPC).

AIMS

This systematic review synthesized the implementation of EPC on the QoL of caregivers of cancer patients.

METHODS

The search was undertaken using seven electronic databases: Medline, Embase, CINAHL, CENTRAL, Web of Science, Scopus, and ProQuest Dissertation & Theses (PQDT). The search strategy integrated relevant terms of early palliative care, caregivers, cancer, and quality of life and was conducted until March 14, 2022. The thematic data analysis approach was used to integrate the results.

RESULTS

Using advanced search features, 4193 studies were obtained on the initial search. After screening and quality assessment, eight studies were included. Eight studies depicted that EPC interventions were delivered for caregivers of patients with advanced cancer, that is, those with a life expectancy of at least 4-24 months or considered intermediate to poor prognosis. One study provided the intervention for caregivers of patients newly diagnosed with cancer. None of the studies had the same protocol or content in delivering EPC for caregivers. Four studies gave similar details on addressing the strategies for caregivers in several aspects, including physical, psychological, social, and spiritual. There was no difference in the QoL between caregivers with cancer patients who received EPC compared with usual care. EPC was noted to influence other factors, such as caregivers' psychological distress and burden.

LINKING EVIDENCE TO ACTION

The data on EPC interventions portray no beneficial effects on the QoL of caregivers with cancer patients. Further studies on developing standard protocols of EPC, multidisciplinary team, and how early it should be given to caregivers are strongly recommended.

Effectiveness of a perioperative support programme to reduce psychological distress for family caregivers of patients with early-stage lung cancer: study protocol for a randomised controlled trial

INTRODUCTION

Family caregivers play a key role in providing ongoing long-term care and assistance to their loved ones during cancer treatment. However, family caregivers of patients with lung cancer are frequently unprepared for their roles and they may undergo psychological distress, thus reducing their own quality of life while affecting patients' health outcomes. Interventions that specifically target this population are lacking. This study aims to evaluate the effectiveness of a perioperative support programme on family caregivers of patients with early-stage lung cancer.

METHODS AND ANALYSIS

This study is guided by the Stress-Coping Model. Family caregivers of patients diagnosed with early-stage lung cancer and those who are scheduled for lung resection treatment will be invited to participate. Participants will be randomised to groups that either receive the perioperative support programme or usual care. The intervention consists of four face-to-face intervention sessions during the hospital stay and two weekly telephone follow-up sessions after discharge. Primary and secondary outcomes will be assessed at baseline and at 4 and 12 weeks after the intervention. Primary outcomes will include psychological distress and secondary outcomes will include caregiving burden, quality of life, coping style and social support. Generalised estimation equation model will be used to analyse the intervention effects.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University (LYG2022003). The authors will disseminate the study's findings by publishing them in international scientific journals.

TRIAL REGISTRATION NUMBER

ChiCTR2200058280.