Authors' recommendations: Overall, low-quality evidence shows that direct interventions have a small effect on reducing distress for informal caregivers of people at the end of life, but no effect on helping them cope. Among the different types of direct interventions, moderate-quality evidence shows which ones are associated with reduced distress—those which combine general advice and support with educational strategies to help the caregivers improve their coping and communication skills (i.e., helping them to communicate openly about illness with the dying person, and to obtain information to reduce uncertainty). However, despite their aim to improve coping skills, these interventions had no impact on coping. The evidence regarding direct interventions comes from 9 fairly recent RCTs. Evidence of very low quality suggests that the indirect interventions included in the systematic review did not have an effect on informal caregivers' distress. These interventions were evaluated in 2 RCTS, 1 published in 1992 and the other in 1984; and there were no studies that evaluated the effect of indirect interventions on the caregivers' ability to cope. This points to a need for more-recent RCTs to study the effects of indirect supportive interventions on informal caregivers' coping and distress. Some of the major limitations of this rapid review: - Although the systematic review that we relied on—the review by Candy and colleagues—has a high AMSTAR rating and asks a research question similar to ours, it missed a large proportion of the relevant body of evidence. For instance, we identified 3 other systematic reviews on the topic, and there was little overlap between the primary studies they included and the studies Candy et al included. (1, 5, 6, 9) This was true after considering both included and excluded studies. - Some types of supportive interventions, such as respite care, were not considered in the RCTs included in the Candy et al review. Hence, there is a gap in the types of interventions that were considered in this rapid review. - Lastly, 10 of the 11 RCTs in the systematic review were conducted with informal caregivers of cancer patients. Hence, the results of this rapid review might have limited generalizability to informal caregivers of non-cancer patients.

Project Status: Completed

Year Published: 2014

URL for published report: http://www.hqontario.ca/Portals/0/Documents/eds/rapid-reviews/eol-supportive-interventions-1411-en.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Health Quality Ontario

Contact Address: Evidence Development and Standards, Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, Ontario Canada M5S 1N5

Contact Name: EDSinfo@hqontario.ca

Contact Email: OH-HQO_hta-reg@ontariohealth.ca

Copyright: Health Quality Ontario