Excerpt

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. This project was nominated by Sonja Batten, PhD, Office of Mental Health Services. The key questions and scope were refined with input from a technical expert panel.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
  • SUMMARY AND DISCUSSION
  • ABBREVIATIONS TABLE
• INTRODUCTION
  • BACKGROUND
  • DEFINITIONS OF KEY CONCEPTS OF FAMILY AND OUTCOMES
  • CATEGORIZATION OF INTERVENTIONS
  • OBJECTIVES
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • STRENGTH OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • STUDY DESIGN AND QUALITY
  • CANCER
  • MEMORY-RELATED DISORDERS
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE FOR CANCER TRIALS
  • SUMMARY OF EVIDENCE FOR MEMORY TRIALS
  • CONCLUSIONS
  • LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
• REFERENCES
• APPENDIX A SEARCH STRATEGIES
• APPENDIX B CRITERIA USED IN QUALITY ASSESSMENT
• APPENDIX C PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX D EVIDENCE TABLES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center, Minneapolis, MN, Timothy J. Wilt, M.D., M.P.H., Director.

Suggested citation:

Griffin JM, Meis L, Greer N, Jensen A, MacDonald R, Rutks I, Carlyle M, and Wilt TJ. Effectiveness of Family and Caregiver Interventions on Patient Outcomes among Adults with Cancer or Memory-Related Disorders: A Systematic Review. VA-ESP Project #09-009; 2013.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at Minneapolis VA Medical Center, Minneapolis, MN funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.