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Palliative care reduces caregiver burden, alleviates patient symptoms, and supports treatment decision-making. However, despite these benefits, there is limited evidence on the effectiveness of palliative care interventions for caregivers of individuals with advanced dementia.
To integrate and analyze data on the effectiveness of palliative care interventions in improving caregiver outcomes in order to ensure that both patients and caregivers receive the support necessary for optimal care experiences, quality of life management, and advanced care planning.
A systematic search was conducted of six databases to identify relevant studies published from database inception to 12 December 2024. Randomized controlled trials (RCTs) investigating palliative care interventions for caregivers of people with advanced dementia were included. Version 2 of the Cochrane Risk of Bias tool was used to assess the risk of bias in the methodology of each study. Standardized mean differences (SMDs) between each intervention and control group were calculated. A random-effects DerSimonian and Laird model was applied to generate pooled SMD estimates for each outcome and assess its heterogeneity. A leave-one-out sensitivity analysis was performed to ensure the stability of the pooled effect sizes.
Eight RCTs were included in the final analysis. Palliative care interventions appeared to reduce conflict in decision-making among caregivers of people with advanced dementia.
Palliative care interventions were successful in reducing conflict in decision-making of caregivers of people with advanced dementia. However, the modality's effects on caregiver satisfaction and caregiver distress need further investigation.
Future palliative care interventions for caregivers of advanced dementia patients should focus on developing the contents of palliative care materials based on evidence-based evaluations and explore strategies to improve engagement between patients, caregivers, and healthcare professionals.
To synthesise evidence on critical care nurses supporting bereaved families in intensive care units (ICUs).
Noblit and Hare's meta-ethnography approach.
We followed Noblit and Hare's 7-phase procedure, using reciprocal translation for data analysis and line-of-argument synthesis. We included studies on registered nurses in adult ICUs with experience supporting bereaved families, using qualitative or mixed-methods studies in English and published in peer-reviewed sources.
Five databases were searched without date restrictions, concluding in January 2024.
The final sample included 24 studies published between 1995 and 2023. The metaphor “Candlelight guides the way through winter's chill” symbolised the crucial role of critical care nurses in supporting bereaved families in ICUs. The synthesis encapsulated two themes: (1) challenges in providing bereavement support, with subthemes of emotional intricacies in bereavement support, and ICU setting limitations; and (2) optimising families' bereavement experiences, with subthemes support systems and emotional commitment, professional nursing behaviours and care practices, and curating personalised and meaningful farewell experiences.
Bereavement support in ICUs poses significant challenges, highlighting the need for greater support for critical care nurses. Nonetheless, these nurses draw on support systems and emotional dedication to overcome obstacles, striving to optimise families' bereavement experiences.
Our findings highlight the importance of structured training programmes (peer support and emotional management) and systemic improvements (optimised workflows and adequate staffing) to enhance quality bereavement care.
This study interprets critical care nurses' experiences supporting bereaved families in intensive care, highlighting the emotional demands. The findings offer insights into improving end-of-life and bereavement care practices and policies, benefiting nurses and families.
This review followed the ENTREQ guidelines for reporting meta-ethnography.
There was no patient or public contribution, as the data were drawn from previously published studies.
CRD42024506847 [PROSPERO]
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