Effectiveness of family dignity intervention for patients in palliative care and their family caregivers-a systematic review and meta-analysis of randomized controlled trials

Objectives: This study explores the impact of family dignity interventions (FDI) on palliative patients and their family caregivers through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: A systematic search was conducted in PubMed, Embase, and Cochrane databases for RCTs related to family-centered dignity interventions, with the search period extending from the inception of the databases up to July 2024. Statistical analyses were conducted using standardized mean difference (SMD) as the effect size with Stata 17.0 software for analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was employed to assess the certainty of evidence.

Results: A total of 7 RCTs involving 556 pairs of palliative patients and their caregivers were included. Compared to the control group, palliative patients who received FDI demonstrated greater improvements in dignity (SMD, - 0.27; 95% confidence interval (CI), - 0.43; - 0.10), hope (SMD, 0.50; 95% CI, 0.24; 0.75), sense of meaning (SMD, 0.39; 95% CI, 0.18; 0.75), and spiritual well-being (SMD, 0.43; 95% CI, 0.24; 0.61). Concurrently, their family caregivers experienced more significant reductions in anxiety (SMD, - 0.61; 95% CI, - 0.92; - 0.30), depression (SMD, - 0.52; 95% CI, - 0.69; - 0.34), and anticipatory grief (SMD, - 0.71; 95% CI, - 1.12; - 0.31). Subgroup analysis indicated that the benefits gained by palliative patients disappeared 2 months after the intervention, whereas the benefits for their family caregivers persisted 2 months after the intervention.

Conclusion: Current low-quality evidence suggests that FDI may have short-term positive effects on the psycho-spiritual well-being of palliative care patients and reduce psychological distress in their family caregivers. Future research should focus on conducting high-quality RCTs to assess the dose-response effect of FDI on the families of palliative care patients, providing evidence to optimize intervention strategies.