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Family strengths can be used to help families adapt to hardship and strain. However, meta-analytic evidence of the effectiveness of family involvement interventions on fear of cancer recurrence (FCR) in women with breast cancer and their caregivers is lacking.
To evaluate the effectiveness of family involvement interventions on FCR in women with breast cancer and their caregivers and to identify the characteristics of effective family involvement interventions.
Ten electronic databases were searched from database inception to October 2023. The updated Cochrane risk-of-bias tool was used to assess the quality of the included randomised controlled trials (RCTs). Data analyses were executed with Revman 5.3 software, and subgroup analyses were performed on the basis of interventional dosage. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 checklist was employed to provide guidance.
Seven studies were included in the review, and six were included in the meta-analysis. The main contents included content related to the disclosure of disease-related feelings/worries/concerns/experiences, education/psychological support plus some disclosure and education/counselling based on disclosure content. The results of the meta-analysis showed that family involvement interventions have large short-term positive effects on relieving FCR in women with breast cancer. The pooled results of subgroup analysis demonstrated that compared with usual care, education/psychological support plus some disclosure is ineffective, and disclosure alone has a moderate-to-large effect size, whereas disclosure with education or counselling targeting the specific needs of participants has an extremely large effect size. Only one study focused on FCR in caregivers, with an unfavourable result.
Family involvement interventions, especially those using disclosure combined with education or counselling targeting their specific needs, have considerable short-term effects on women's FCR alleviation. However, the evidence in caregivers is insufficient. Only a few interventional studies targeting patients and caregivers exist. Further high-quality RCTs with follow-ups are encouraged.
No patient or public contribution.
The fear of cancer recurrence (FCR) levels reported by caregivers are as high as those reported by women with breast cancer, with some caregivers even reporting FCR levels higher than women with breast cancer. The recognition of factors associated with caregiver FCR is important for providing proactive support to caregivers at risk.
To identify factors associated with high FCR in caregivers of women with breast cancer.
A systematic search of eight electronic databases was conducted from database inception to August 2023. The identified papers were screened, and their full texts were further assessed. The quality of the included studies was examined by using a checklist, and relevant data were extracted with a predeveloped data extraction form. The best-evidence synthesis model was used for data synthesis. Meta-analysis was conducted to calculate the prevalence of caregiver FCR.
The search yielded a total of 2137 studies, and 15 studies involving 2461 caregivers were included after the screening and full assessment of 56 papers. A total of 29 factors were identified. Of these factors, five factors with a moderate level of evidence associated with high FCR were identified: insufficient communication of women with breast cancer, low level of resilience, high social constraints, high protective buffering and insufficient communication of caregivers; 15 associated factors were supported by limited-level evidence and nine were supported by conflicting-level evidence. The prevalence of FCR in caregivers was 45%.
The associated factors examined provide some evidence for identifying caregivers who are at high risk of high FCR. Identifying factors contributing to FCR in caregivers is important for developing interventions for those caregivers most in need and reducing adverse health outcomes related to caregiver FCR. Additional studies are needed to examine the relationship between conflicting factors and caregiver FCR.
No patient or public contribution.
Trial Registration: PROSPERO registration number: CRD42023469754; identifier: https://www.crd.york.ac.uk/PROSPERO/#recordDetails
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