Christina Yeni Kustanti1, Hui-Fen Fang2, Xiao Linda Kang3, Jeng-Fong Chiou4, Shen-Chi Wu5, Ninik Yunitri6, Hsin Chu7, Kuei-Ru Chou8. 1. PhD Student of School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan and Lecturer of Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum, Yogyakarta, Indonesia. 2. Director of Nursing department, Taipei Cancer Center, Taipei Medical University, Deputy Director of Cancer Center, Taipei Medical University Hospital and Deputy Director of Nursing Service, Taipei Medical University Hospital, Taipei, Taiwan. 3. Postdoctoral Researcher of School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan and School of Nursing, University of Pennsylvania, USA. 4. Professor, Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University and Attending Physician, Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan. 5. Attending Physician of Department of Palliative Medicine Division, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan. 6. PhD Student of School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan and Lecturer of Mental Health and Psychiatric Nursing Department, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Indonesia. 7. Associate Professor of Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan and Attending Physician of Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. 8. Lambda Beta-at-Large, Distinguished Professor of School of Nursing and Dean of College of Nursing, Taipei Medical University, Taipei, Taiwan and Vice Director of Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan and Center for Nursing and Healthcare Research in Clinical Practice Application Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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.
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.