Psychosocial Interventions at the End-of-Life

Abstract

Background The integration of holistic and effective end-of-life (EOL) care into cancer management has increasingly become a recognized field. People living with terminal cancer and their caregivers face a unique set of emotional, spiritual, and social stressors, which may be managed by psychosocial interventions. Objectives This study aimed to explore the types and characteristics of psychosocial interventions at the EOL for adult cancer patients and their caregivers and to identify gaps in the current literature. Methods A systematic search was conducted through MEDLINE (Ovid) and CINAHL from January 1, 2011, to January 31, 2021, retrieving 2453 results. A final 15 articles fulfilled the inclusion criteria, reviewed by 2 independent reviewers. Ten percent of the original articles were cross-checked against study eligibility at every stage by 2 experienced researchers. Results Most interventions reported were psychotherapies, with a predominance of meaning or legacy-related psychotherapies. Most interventions were brief, with significant caregiver involvement. Most studies were conducted in high-income, English-speaking populations. Conclusion There is robust, although heterogeneous, literature on a range of psychosocial interventions at the EOL. However, inconsistencies in the terminology used surrounding EOL and means of outcome assessment made the comparison of interventions challenging. Implication for Practice Future studies will benefit from increased standardization of study design, EOL terminology, and outcome assessment to allow for a better comparison of intervention efficacy. There is a need for increased research in psychosocial interventions among middle- to low-income populations exploring social aspects, intimacy, and the impact of COVID-19.

Death education interventions for people with advanced diseases and/or their family caregivers: A scoping review

“…16 Existing reviews are also limited to certain types of interventions, especially life review, dignity therapy, meaning-centered psychotherapy, cognitive-behavioral therapy, and the Managing Cancer and Living Meaningfully. 5,9,11,[14][15][16][17]19 Psychological outcomes, such as anxiety and depression, 5,9,11,[14][15][16]19 and quality of life 9,[15][16][17][18][19] were frequently measured in these reviews; spiritual outcomes, such as spiritual well-being, and death-related outcomes, such as attitudes toward death, were less assessed, despite being essential domains in death education. 2,20,21 Almost all existing articles are systematic reviews that evaluated the interventions' effectiveness, 5,9,[12][13][14][15][16][17][18][19] but did not determine factors that contributed to success of the intervention.…”

“…8 Research on death education interventions for patients with advanced diseases and/or family caregivers has increased, but recent reviews on death education interventions have some limitations. 5,[9][10][11][12][13][14][15][16][17][18][19] Despite that patients with non-cancer diseases dominate the total population of people with advanced diseases, approximately half of existing reviews focused on patients with advanced cancer, 5,13,15,17 Thus far, only one review focused on patients with heart failure. 16 Existing reviews are also limited to certain types of interventions, especially life review, dignity therapy, meaning-centered psychotherapy, cognitive-behavioral therapy, and the Managing Cancer and Living Meaningfully.…”