Effectiveness of Family and Caregiver Interventions on Patient Outcomes among Adults with Cancer or Memory-Related Disorders: a Systematic Review

Two federal laws have been signed in the last five years that have expanded the Veterans Health Administration's (VHA) authority to provide services to families of Veterans. This expansion allows the VHA to provide a number of clinical and support services, training, and education to families and caregivers of patients with service connected and non-service connected injuries or conditions. The VHA has responded by initiating a set of support services, including counseling, a caregiver...
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Two federal laws have been signed in the last five years that have expanded the Veterans Health Administration's (VHA) authority to provide services to families of Veterans. This expansion allows the VHA to provide a number of clinical and support services, training, and education to families and caregivers of patients with service connected and non-service connected injuries or conditions. The VHA has responded by initiating a set of support services, including counseling, a caregiver support line, and website, to support families and caregivers of Veterans. With this new authorization, there is now the potential to adopt or integrate additional family-involved interventions to improve Veterans' outcomes. This review's aim was to evaluate which interventions are efficacious in affecting patient outcomes for memory-related disorders or cancer. Family and caregiver interventions, especially interventions targeted to caregivers caring for someone with a physical health condition, typically aim to develop caregiver skills to manage their caregiving tasks and to reduce caregiver burden. An often implicit assumption in these interventions is that by reducing caregiver burden and improving caregiver skills, the care recipient will also benefit. Reflecting this, the majority of family-focused intervention studies and reviews of these studies have concentrated only on family or caregiver outcomes. We conducted a systematic review of interventions that explicitly tested this assumption. We evaluated the published evidence assessing whether family involved interventions improve patient outcomes (i.e., efficacy) and whether specific family involved interventions are better than alternative ones (i.e., specificity or comparative effectiveness). We specifically examined the effects of family-involved interventions on the patients, not on the family members. We assessed if there is evidence that interventions targeted at family members only or both family members and adult care recipients improve the patients' outcomes. We limited our focus to family members caring for those with cancer and memory-related conditions since the majority of studies examine one of these two conditions. The key questions and scope were refined with input from a technical expert panel. We addressed the following key questions: Key Question #1. What are the benefits of family and caregiver psychosocial interventions for adult patients with cancer or memory-related disorders compared to usual care or wait list? a. What are the harms of these interventions? b. Do these benefits/harms vary by type of intervention, health condition, or patient functional status, or across outcomes? Key Question #2. What are the benefits of one family or caregiver oriented psychosocial intervention compared to either: 1) a patient-directed intervention, or 2) another alternative family-oriented intervention in improving outcomes for adult patients with cancer or memory-related disorders? a. What are the harms of these interventions? b. Do these benefits/harms vary by type of intervention, health condition, or patient functional status, or across outcomes?