What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature

MacLeod, Sheena; Elliott, Lawrie; Brown, Richard J.

doi:10.1016/j.ijnurstu.2010.09.005

Cited by 66 publications

(78 citation statements)

References 154 publications

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“…Of the reviews, 14 [19][20][21][22][23][24][25][26][27][28][29][30][31][32] focused on interventions for carers of people with dementia, four [33][34][35][36] focused on carers of people with cancer, four [37][38][39][40][41] focused on carers of people with stroke, three [42][43][44] focused on carers of people with various conditions at the end of life and two 45,46 focused on carers of people with mental health problems. Not all reviews reported the geographic location of the included primary studies.…”

Section: Overview Of the High-quality Reviewsmentioning

confidence: 99%

“…Multicomponent interventions were the focus in many reviews; those with psychosocial or psychoeducational content featured prominently, 28,[34][35][36][37][38]46 as did those containing education and/or communication skills training. 21,24,26,40,44,45 Other (more specific) interventions included stroke liaison workers, 39 volunteer mentoring, 32 meditation-based activity, 23 art-making classes 33 and home-based exercise. 29 Control or comparator groups (when reported) were usual care, no control, other active intervention, wait list or placebo.…”

Section: Overview Of the High-quality Reviewsmentioning

confidence: 99%

“…A quality assessment of primary studies was carried out in 25 [19][20][21][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40][41][42][43][44][45][46] of the 27 included reviews. In most cases, it was possible to determine at least the overall quality of the included studies.…”

Section: Quality Of the Primary Studiesmentioning

confidence: 99%

“…In Eggenberger et al, 21 quality assessment criteria were presented in the paper, but detailed results were not. Similarly, in Macleod et al, 45 risk of bias was reported to have been assessed, but the results of this were not presented. Two reviews 22,34 did not perform any quality assessment of primary studies.…”

Section: Quality Of the Primary Studiesmentioning

confidence: 99%

“…The multicomponent nature of many interventions meant that it was difficult to identify causal relationships. Eleven reviews undertook narrative synthesis 19,[21][22][23]28,32,35,36,[43][44][45] and six undertook quantitative synthesis. 20,26,27,29,30,34 Ten reviews 24,25,31,33,[37][38][39][40][41][42]46 contributed both narrative and quantitative syntheses.…”

Section: Approach To Synthesismentioning

confidence: 99%

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Updated meta-review of evidence on support for carers

Thomas

Dalton

Harden

et al. 2017

Health Serv Deliv Res

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BackgroundPolicy and research interest in carers continues to grow. A previous meta-review, published in 2010, by Parkeret al.(Parker G, Arksey H, Harden M.Meta-review of International Evidence on Interventions to Support Carers. York: Social Policy Research Unit, University of York; 2010) found little compelling evidence of effectiveness about specific interventions and costs.ObjectiveTo update what is known about effective interventions to support carers of ill, disabled or older adults.DesignRapid meta-review.SettingAny relevant to the UK health and social care system.ParticipantsCarers (who provide support on an unpaid basis) of adults who are ill, disabled or older.InterventionsAny intervention primarily aimed at carers.Main outcome measuresAny direct outcome for carers.Data sourcesDatabase searches (including Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Applied Social Sciences Index and Abstracts and Social Care Online) for systematic reviews published from January 2009 to 2016.Review methodsWe used EndNote X7.4 (Thomson Reuters, CA, USA) to screen titles and abstracts. Final decisions on the inclusion of papers were made by two reviewers independently, using a Microsoft Excel®2013 spreadsheet (Microsoft Corporation, Redmond, WA, USA). We carried out a narrative synthesis structured by patient condition and by seven outcomes of interest. We assessed the quality of the included systematic reviews using established criteria. We invited a user group of carers to give their views on the overall findings of our review.ResultsSixty-one systematic reviews were included (27 of high quality, 25 of medium quality and nine of low quality). Patterns in the literature were similar to those in earlier work. The quality of reviews had improved, but primary studies remained limited in quality and quantity. Of the high-quality reviews, 14 focused on carers of people with dementia, four focused on carers of those with cancer, four focused on carers of people with stroke, three focused on carers of those at the end of life with various conditions and two focused on carers of people with mental health problems. Multicomponent interventions featured prominently, emphasising psychosocial or psychoeducational content, education and training. Multiple outcomes were explored, primarily in mental health, burden and stress, and well-being or quality of life. Negative effects following respite care were unsupported by our user group. As with earlier work, we found little evidence on intervention cost-effectiveness. No differences in review topics were found across high-, medium- and low-quality reviews.LimitationsThe nature of meta-reviews precludes definitive conclusions about intervention effectiveness, for whom and why. Many of the included reviews were small in size and authors generally relied on small numbers of studies to underpin their conclusions. The meta-review was restricted to English-language publications. Short timescales prevented any investigation of the overlap of primary studies, and growth in the evidence base since the original meta-review meant that post-protocol decisions were necessary.ConclusionsThere is no ‘one size fits all’ intervention to support carers. Potential exists for effective support in specific groups of carers. This includes shared learning, cognitive reframing, meditation and computer-delivered psychosocial support for carers of people with dementia, and psychosocial interventions, art therapy and counselling for carers of people with cancer. Counselling may also help carers of people with stroke. The effectiveness of respite care remains a paradox, given the apparent conflict between the empirical evidence and the views of carers.Future workMore good-quality, theory-based, primary research is warranted. Evidence is needed on the differential impact of interventions for various types of carers (including young carers and carers from minority groups), and on the effectiveness of constituent parts in multicomponent programmes. Further research triangulating qualitative and quantitative evidence on respite care is urgently required. The overlap of primary studies was not formally investigated in our review, and this warrants future evaluation.Study registrationThis study is registered as PROSPERO CRD42016033367.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Overview Of the High-quality Reviewsmentioning

confidence: 99%

Section: Overview Of the High-quality Reviewsmentioning

confidence: 99%

Section: Quality Of the Primary Studiesmentioning

confidence: 99%

Section: Quality Of the Primary Studiesmentioning

confidence: 99%

Section: Approach To Synthesismentioning

confidence: 99%

See 3 more Smart Citations

Updated meta-review of evidence on support for carers

Thomas

Dalton

Harden

et al. 2017

Health Serv Deliv Res

View full text Add to dashboard Cite

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Assessment of the Burden of Care and Quality of Life of Caregivers in Schizophrenia

Boyer

Baumstarck

Auquier

2016

Beyond Assessment of Quality of Life in Schizophrenia

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Families in Assertive Community Treatment (ACT) Teams in Norway: A Cross-Sectional Study on Relatives’ Experiences of Involvement and Alienation

Weimand

Israel

Ewertzon

2017

Community Ment Health J

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International research shows that relatives of people with mental illness are rarely involved by mental health services. Assertive Community Treatment (ACT) has been recently implemented in Norway. The experience of relatives of ACT users is largely unknown. The aim of this study was to explore relatives' experience with ACT-teams in Norway. Data were collected using the family involvement and alienation questionnaire, consisting of experiences of approach, and alienation from the provision of professional care. 38 Relatives participated in this study. A majority experienced a positive approach (openness, confirmation, and cooperation) from the ACT teams, which also was considered better compared to previous services. They considered openness and cooperation as essential aspects from the professionals. Almost half did not feel alienated (powerlessness and social isolation). Higher level of being approached positively was significantly associated with lower level of feeling alienated. The knowledge of what constituted relatives' positive experiences with the ACT teams should be transferred into practice regarding how to form a positive alliance with relatives.

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What support can community mental health nurses deliver to carers of people diagnosed with schizophrenia? Findings from a review of the literature

Cited by 66 publications

References 154 publications

Updated meta-review of evidence on support for carers

Updated meta-review of evidence on support for carers

Assessment of the Burden of Care and Quality of Life of Caregivers in Schizophrenia

Families in Assertive Community Treatment (ACT) Teams in Norway: A Cross-Sectional Study on Relatives’ Experiences of Involvement and Alienation

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