The Effectiveness of Bereavement Support for Adult Family Caregivers in Palliative Care: A Meta‐Analysis of Randomized Controlled Trials

Abstract

Purpose This meta‐analysis aimed to summarize and synthesize the effectiveness of bereavement support for adult family caregivers in palliative care. Methods Meta‐analysis was conducted. The databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, Medline, PubMed, Scopus, and Web of Science were comprehensively searched from inception until January 2020. This study followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and standard methods for conducting a meta‐analysis. Data analysis was performed using Comprehensive Meta‐analysis version 3.0, and the random‐effects model was adopted. Findings In total, 19 randomized controlled trials with an overall sample size of 2,690 participants met the inclusion criteria. The study showed that bereavement support had a significant effect on reducing grief (Hedges’ g score = ‐0.198; 95% confidence interval [CI] ‐0.310 to ‐0.087), depression (Hedges’ g score = ‐0.252; 95% CI ‐0.406 to ‐0.098), and anxiety (Hedges’ g score = ‐0.153; 95% CI ‐0.283 to ‐0.023); however, high heterogeneity was present. No statistically significant difference was shown for traumatic feelings. Based on moderator analysis, a group format was more effective for grief, a combined individual and group format for depression, and an individual format for anxiety. Bereavement support was more effective when delivered by professionals, when delivered in more than six sessions, and need to be evaluated within 6 months. Conclusions Bereavement support was effective in reducing grief, depression, and anxiety. The majority of the included studies had moderate heterogeneity, which limited the comparability of the evidence. Therefore, more robust randomized controlled trials are needed to confirm these study results. Clinical Relevance This meta‐analysis provides evidence that bereavement support delivered in the palliative care setting is effective for reducing grief, depression, and anxiety. Nurses and other healthcare professionals can make recommendations for adult family caregivers based on this study in reducing psychological symptoms due to a loss in the palliative care domain.

Healthcare Professionals’ Perceptions of Support for Family Members in Specialist Palliative Care Inpatient Units – a Qualitative Descriptive Study

“…The health care system was constructed mainly to focus on the patients, and systematic support options and interventions for FMs in inpatient palliative care were absent [5]. Furthermore, an organised bereavement support system was lacking, even though bereavement support would be helpful to assist FMs to cope with the grieving process [3]. In addition, the HCPs described that they would want to have more training in family care in a palliative care setting, and this lack of su cient training in family care has been stated before [9].…”

“…Particularly in inpatient care, where FMs value the professional and safe care of the patient, they expect support from the HCPs, including empathy, compassion, involvement in the care and privacy regarding their personal space [2]. Furthermore, bereavement support is bene cial to help with grief management and for FMs to cope psychologically [3]. However, even though FMs experience better support in palliative care units than in other care settings, they still report inadequate support and information sharing [4].…”

“…The importance of supporting FMs has been acknowledged [1,3,6,7], and it is known that the support is not always optimal [4,9]. In addition, HCPs face challenges looking after the families [6,8].…”

Prevalence of grief disorders in bereaved families of cancer patients: A meta-analysis

“…Approximately 9.8% of bereaved persons in the general population experience prolonged grief disorder. 6 Without monitoring and treatments such as psychotherapy interventions 7 or bereavement supports, 8 this condition can lead to adverse health effects, including increased tobacco use and alcohol drinking, several psychosomatic and psychiatric disorders, and the risk of death from physical problems or suicide. 9,10 This condition can negatively affect the relationship dynamics and the family roles.…”

Experience of symptom control, anxiety and associating factors in a palliative care unit evaluated with Support Team Assessment Schedule Japanese version

“…Amelioration of their psychological difficulties might raise care quality 26 . Bereavement support for caregivers is also known to reduce their grief, depression, and anxiety 27 . Early recognition of their difficulties, including anxiety, might also help establish family psychological care.…”