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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

The impact of caring for those with chronic obstructive pulmonary disease (COPD) on carers' psychological well-being: a narrative review

M Grant, A Cavanagh, and J Yorke.

Review published: 2012.

Link to full article: [Journal publisher]

CRD summary

The authors appeared to conclude that it was not possible to gauge the impact of caregiving on the psychological outcomes of caregivers to patients with COPD. Further research was recommended. The authors' conclusion reflects the evidence presented, but methodological concerns in the review means that it's reliability is unclear.

Authors' objectives

To evaluate the psychological outcomes of caregiving to patients with chronic obstructive pulmonary disease (COPD), and to assess the perceived adequacy of professional support. Factors leading to psychological stress, and relationship dynamics between the caregiver and patient were also evaluated, but these do not form part of this abstract.

Searching

MEDLINE, CINAHL, PsycINFO, Sociological Abstracts and The Cochrane Library were searched for studies published in English between December 2008 and June 2011. Search terms were reported. Reference lists were scanned for additional studies.

Study selection

Eligible for inclusion were studies that reported the caregiver's perspective of providing care to patients with COPD, with specific focus on psychological well-being of the caregiver and the perceived adequacy of service from health professionals. Caregivers had to be at least 18 years old.

Qualitative and quantitative studies were included. These were mainly conducted in the United States, Canada, Japan and Australia. Over half the studies only focused on the caregiver (mainly females who were spouses/partners); others included the caregiver and the patient. Outcomes were measured with various methods; including those that focused on caregiver psychological distress (depression, stress and mood, mental health, use of psychotropic drugs), burden of care and perceived adequacy of professional support.

The authors did not state how many reviewers selected the studies for inclusion.

Assessment of study quality

There was no reported assessment of study quality.

Data extraction

Various qualitative and quantitative data were extracted, including proportions, means/standard deviations, and participant quotations (qualitative studies). Statistical significance was presented in some cases.

The authors did not state how many reviewers were involved in data extraction.

Methods of synthesis

A narrative synthesis was presented. Findings from qualitative and quantitative studies were generally presented separately. There was some evidence of mixed-method synthesis, but the method was undefined.

Results of the review

Twenty studies were included in the review (1,456 caregivers in total). There were 13 quantitative (cross-sectional/descriptive studies) and seven qualitative studies.

Caregiver psychological distress (seven quantitative studies): The evidence was mixed, and no firm conclusions could be drawn on the impact of caregiving on psychological outcomes.

Burden of care (four qualitative studies): There were reports of caregiver burden in respect of the multiple roles that caregivers had to adopt, and in particular the difficulty of having to be on alert though the night. One study reported caregiving as a positive experience.

Perceived adequacy of professional support (two quantitative studies, five qualitative studies): Lack of information on the disease trajectory and symptom management was reported as a concern in two qualitative and one quantitative study. Knowledge of, and access to, support services was considered to be a problem (three qualitative studies, one quantitative study). Reluctance to access services was reported in two qualitative studies and one quantitative study. Care support by a specialist nurse was considered to be a positive factor (one qualitative study).

Authors' conclusions

The authors appeared to conclude that it was not possible to gauge the impact of caregiving on the psychological outcomes of caregivers to patients with COPD. Further research was recommended.

CRD commentary

The review question was clear and inclusion criteria were adequately presented. Appropriate databases were searched, but the restriction to published studies in English meant relevant studies may have been overlooked. The review process was not reported so potential for error and bias could not be ruled out. There was no reported quality assessment of included studies. Various qualitative methodologies were used, and the included quantitative designs were traditionally associated with lower quality.

Study details were presented, but the information provided on setting and caregiver characteristics was inconsistently reported and this limited the ability to compare across studies. There was some use of participant quotations in the qualitative studies, and raw data for the quantitative studies was reported sporadically. Not all studies focused on the impact of caregiving on caregivers as the primary objective, and the presentation of findings did not allow verification in a systematic way. There was substantial heterogeneity in the outcome measures, and elements of the caregiving process were not clearly described.

This review is relevant to UK health and social care policy, and the authors' conclusion reflects the evidence presented. A number of methodological concerns in the review means that it's reliability is unclear.

Implications of the review for practice and research

Practice: The authors stated that nurses working with patients with COPD should consider the psychological needs of caregivers and offer greater support.

Research: The authors stated that further research was needed to clarify the psychological outcomes of caregivers who look after patients with COPD. Studies should also explore the disease specific factors that predict caregiver health outcomes so that interventions could be developed and evaluated. Rigorous, longitudinal studies using age-matched comparative controls were required.

Funding

Not stated.

Bibliographic details

Grant M, Cavanagh A, Yorke J. The impact of caring for those with chronic obstructive pulmonary disease (COPD) on carers' psychological well-being: a narrative review International Journal of Nursing Studies 2012; 49(11): 1459-1471. [PubMed: 22386988]

Indexing Status

Subject indexing assigned by NLM

MeSH

Caregivers /psychology; Humans; Pulmonary Disease, Chronic Obstructive /nursing /psychology

AccessionNumber

12012056889

Database entry date

16/07/2013

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 22386988

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