Involvement of informal caregivers in supporting patients with COPD: a review of intervention studies

Figures & data

Table 1 Assessment of methodological quality of included intervention studies according to EPOC risk of bias criteria

Study	Allocation sequence	Concealment of allocation	Baseline outcome measurements	Baseline characteristics	Incomplete outcome data	Knowledge of allocated interventions	Protection against contamination	Selective outcome reporting	Other risk of bias
Aimonino Ricauda et al^Citation34	L	L	L	L	L	L	L	H	L
Ojoo et al^Citation32	H	L	L	L	L	U	H	L	L
Abad-Corpa et al^Citation33	H	L	L	H	L	U	L	L	L
Egan et al^Citation31	L	U	U	L	L	U	H	L	L
Lainscak et al^Citation36	L	L	U	U	L	L	H	L	H
Boxall et al^Citation30	L	L	L	L	L	H	H	L	L
Jonsdottir et al^Citation37	L	L	L	L	L	U	H	L	L
Marques et al^Citation38	L	L	H	L	L	U	H	L	L
Monninkhof et al^Citation35	H	L	L	L	L	U	H	L	L

Notes: L, low risk of bias; H, high risk of bias; U, unclear risk of bias.

Abbreviation: EPOC, Effective Practice and Organisation of Care.

Table 2 Summary of the roles caregivers can adopt in supporting patients

Role	Description	Benefit of caregiver involvement
Informational	Learning about the disease, its progression, prognosis, and treatment options	Allows caregiver to clarify and reinforce information to the patient Assists with reducing uncertainty and increasing confidence in decision making^Citation40
Providing direct care	Providing assistance with medications, symptom management, and activities of daily living
Encouraging adherence	Supporting and encouraging patients to adhere to treatment regimens or self-management programs	Caregiver support has been shown to increase treatment adherence and self-care behaviors^Citation41,Citation42 May enhance patient skills and confidence to engage in self-care
Acting as an advocate	Assisting to coordinate care across providers and settings Liaising with organizations and health care providers to secure patient entitlements, services, and care	Can enhance communication with the health care team An increased understanding of and control over their treatment options, and higher quality of life^Citation43,Citation44
Providing emotional or psychosocial support	Providing empathy and validation of the patient experience, encouraging patient self-efficacy, coordinating family responsibilities, or taking on new family roles	Can reduce patient distress^Citation45 Can lead to improved communication between the patient and caregiver^Citation46

Figure 1 PRISMA flow chart of search results.

Abbreviations: EPOC, Effective Practice and Organisation of Care; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

Table 3 Specified roles of caregivers in each intervention

Study	Specified caregiver role	Provided to
		Caregiver only	Patient–caregiver dyad
Aimonino Ricauda et al^Citation34	Provided with education about COPD		X
Ojoo et al^Citation32	Provided with education about COPD and provided with “reassurance” (no further details provided)		X
Abad-Corpa et al^Citation33	Provided with education about COPD		X
	Asked for information about problems or needs that might arise on arrival at home		X
Egan et al^Citation31	Provided with education about COPD		X
	Received phone calls on a regular basis from the care manager to ensure that planned outcomes were achieved		X
Lainscak et al^Citation36	Provided with education about COPD		X
	Actively involved in discharge planning process (which involved discharge coordinator assessing patient situation and homecare needs)		X
Boxall et al^Citation30	Provided with education about COPD		X
Jonsdottir et al^Citation37	Provided with education about COPD including skills in communication with family, relatives, and health professionals		X
	Included in 3–4 semistructured conversations with a clinical nurse specialist in respiratory nursing to discuss main concerns, symptoms, nature of the disease, and possibilities for patient/family to prevent further decline of disease within the aim of enhancing health of the patient and family		X
Marques et al^Citation38	Invited to attend weekly psychosocial support and education sessions		X
Monninkhof et al^Citation35	Invited to attend group education sessions about COPD		X

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