Involving caregivers in self‐management interventions for patients with heart failure and chronic obstructive pulmonary disease. A systematic review and meta‐analysis

Abstract

Aim To quantify the impact of involving caregivers in self-management interventions on health-related quality of life of patients with heart failure or chronic obstructive pulmonary disease.

Design Systematic review, meta-analysis.

Data sources Searched: Medline Ebsco, PsycINFO, CINAHL, Embase, Web of Science, The British Library and ProQuest. Search time frame; January 1990–March 2018.

Review Methods Randomized controlled trials involving caregivers in self-management interventions (≥2 components) compared with usual care for patients with heart failure or chronic obstructive pulmonary disease. A matched sample based on publication year, geographic location and inclusion of an exercise intervention of studies not involving caregivers were identified. Primary outcome of analysis was patient health-related quality of life.

Results Thirteen randomized controlled trials (1,701 participants: 1,439 heart failure; 262 chronic obstructive pulmonary disease) involving caregivers (mean age 59; 58% female) were identified. Reported patient health-related quality of life measures included; Minnesota Living with Heart Failure questionnaire, St. George's respiratory questionnaire and Short-Form-36. Compared with usual care, there was similar magnitude in mean improvement in patient health-related quality of life with self-management interventions in trials involving caregivers (SMD: 0.23, 95% confidence interval: −0.15–0.61) compared with trials without caregivers (SMD: 0.27, 0.08–0.46).

Conclusion Within the methodological constraints of this study, our results indicate that involving caregivers in self-management interventions does not result in additional improvement in patient health-related quality of life in heart failure or chronic obstructive pulmonary disease. However, involvement of caregivers in intervention delivery remains an important consideration and key area of research.

Impact Greater understanding and awareness is needed of the methodology of caregiver engagement in intervention development and delivery and its impact on patient outcomes.