Evidence for the Effectiveness of Interventions for Caregivers of People With Chronic Conditions: A Systematic Review

Abstract

Importance: Caregivers are pivotal in supporting the growing population of people with chronic conditions. Yet, engaging in the caregiver role involves the risk of poor outcomes. Caregiver interventions are needed that address poor outcomes while fostering engagement in role-related activities. Objective: To evaluate the evidence for interventions to support caregivers of adults with chronic conditions. Data Sources: Five databases were searched for studies of interventions for caregivers and patient–caregiver dyads published between 1995 and 2019. Study Selection and Data Collection: We reviewed the titles, abstracts, and full-text articles of the initial search results (N = 12,216 studies) according to a predetermined protocol. Findings: Forty-eight studies met the inclusion criteria. Psychoeducation and education with skills training were the two caregiver intervention themes. Studies evaluating psychoeducation (n = 28) provided low strength of evidence for improved psychosocial outcomes. Within this theme, problem-solving and coping skills training were common intervention components associated with significant improvements in depression and quality of life. Studies evaluating education with skills training (n = 20) provided moderate strength of evidence for improved knowledge and low strength of evidence for improved psychosocial outcomes. Dyadic self-management education and hands-on training were common components associated with significant improvements in knowledge, quality of life, and burden or strain. Conclusions and Relevance: We found low strength of evidence to support the use of psychoeducation and education with skills training. Within these approaches, problem-solving and coping skills training, dyadic self-management education, and hands-on training show promise for improving caregiver outcomes. What This Article Adds: Findings of this systematic review are inconclusive with respect to psychoeducation and education with skills training leading to improved caregiver well-being. Within these broad approaches, the findings support the use of problem-solving and coping skills training, dyadic self-management education, and hands-on training to improve knowledge and well-being among caregivers of people with chronic conditions.

A Methodological Approach for Documenting Multi-Component Interventions Targeting Family Caregivers

“…In spite of the increased recognition, evidence for FCG interventions improving the value of care transitions remains insufficient (Meulenbroeks et al, 2021). This evidence gap is congruent with low strength evidence found in FCG interventions aimed at reducing deleterious effects associated with being a FCG (Butler et al, 2020;Rouch et al, 2021) or at improving patient outcomes (Griffin et al, 2014(Griffin et al, , 2015. The best evidence to date suggests that multi-component and collaborative care interventions may improve intervention efficacy (Kamermayer et al, 2017;Scott, 2010), but questions remain about which components or combination of components are critical, and what the optimal dose of those components is.…”

Occupational Therapy Interventions for Older Adults With Chronic Conditions and Their Care Partners

“…For example, home health agencies can provide care partner supportive services such as education and training to Medicare beneficiaries (Centers for Medicare & Medicaid Services, 2017; National Academies of Sciences, Engineering, and Medicine, 2016).In this article, I provide a clinical case report that demonstrates how occupational therapy practitioners can support and participate in this model of care. This case report exemplifies findings of a systematic review on the effectiveness of interventions for care partners of people with chronic conditions, published in the July/August 2021 issue of the American Journal of Occupational Therapy (Rouch et al, 2021). I describe the occupational therapy evaluation and intervention processes for supporting chronic condition self-management, coping skills, and problem solving for an older adult with a chronic condition and his daughter receiving home health occupational therapy services.…”

“…Madeline reviewed the evidence presented in the systematic review by Rouch et al (2021) and found the following relevant information:…”

The Relationship between Personal and Contextual Factors and Participation Restriction in Mid-Life Caregivers

“…Use of respite services is often viewed as the single most helpful resource available to caregivers (Department of Health and Human Services, 2019), and we hypothesized that using respite would free up time to enjoy non-caregiving related activities. Though we recognize that caregiver training may differ substantially based on duration and content, we hypothesized, based on a recent review of the impact of caregiving training activities on multiple caregiver outcomes (Rouch et al, 2021), that any type of caregiver training could be associated with fewer restrictions in participation due to subsequent increased mastery of caregiving.…”