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Am J Hosp Palliat Care. 2016 Nov;33(9):894-908. Epub 2015 Jul 7.

Behavioral and Educational Interventions to Support Family Caregivers in End-of-Life Care: A Systematic Review.

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School of Nursing, University of Washington, Seattle, WA, USA
School of Nursing, University of Washington, Seattle, WA, USA School of Medicine, University of Washington, Seattle, WA, USA.
School of Nursing, University of Washington, Seattle, WA, USA.
School of Social Work, University of Washington, Seattle, WA, USA.


The demand for family caregivers steadily increases as the number of people receiving hospice and palliative care rises. Family caregivers play a significant role in supporting their loved ones in end-of-life care. However, there is limited evidence about the effectiveness of the interventions for supporting family caregivers. This article synthesizes behavioral and educational interventions that support family caregivers in end-of-life care. A systematic review was conducted and searched interventional studies published between 2004 and 2014 in PubMed, CINAHL, Embase, and The Cochrane Library electronic databases. Fourteen studies were identified and analyzed: 4 educational studies, 6 cognitive behavioral therapy studies, and 4 psychoeducational studies. All educational and behavioral interventions had developed structures and treatment manuals and improved family caregivers' outcomes. The cognitive behavioral therapy resulted in more positive outcomes than the other 2 interventions. More rigorous randomized controlled trials are needed to replicate current effective interventions with larger and diverse sample. Future studies need to develop tools for assessing family caregivers' needs, create consistent and specific tools to effectively measure family caregivers' outcomes, incorporate a cost-effectiveness analysis, and find the most efficient intervention format and method.


behavior therapy; cognitive behavioral therapy; cognitive psychotherapy; education; end-of-life care; family caregiver; hospice care; palliative care

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