Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses

BACKGROUND: Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Many caregivers, however, find themselves in a caring role for which they are ill prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical location. OBJECTIVES: The objective of this review was to evaluate the effectiveness of telephone support interventions, delivered by healthcare professionals, when compared to usual care or non-telephone-based support interventions for providing education and psychosocial support for informal caregivers of people with acute and chronic diagnosed illnesses, and to evaluate the cost-effectiveness of telephone interventions in this population. SEARCH METHODS: We searched the following databases from inception to 16 November 2018: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ProQuest Dissertations and Theses A&I; and CINAHL Complete. We also searched 11 caregiver-specific websites, three conference links, and two clinical trial registries. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (including cluster-RCTs) and quasi-RCTs. We excluded cross-over trials because of the high risk of carry-over effects from one intervention to another. DATA COLLECTION AND ANALYSIS: Two authors independently screened citations against the review's inclusion criteria, extracted data, and assessed the included studies using the Cochrane 'Risk of bias' tool. The review's prespecified primary (quality of life and burden) and secondary outcomes (skill acquisition, psychological health, knowledge, health status and well-being, family functioning, satisfaction, and economic outcomes), where reported, were assessed at the end of intervention delivery and at short-term (≤ 3 months), medium-term (> 3 to ≤ 6 months) and longer-term time points (> 6 to 12 months) following the intervention. Where possible, meta-analyses were conducted, otherwise results were reported narratively. MAIN RESULTS: We included 21 randomised studies involving 1,690 caregivers; 19 studies compared telephone support interventions and usual care, of which 18 contributed data to the analyses. Two studies compared telephone and non-telephone professional support interventions. Caregiver ages ranged from 19 years to 87 years across studies. The majority of participants were female (> 70.53%), with two trials including females only. Most caregivers were family members, educated beyond secondary or high school level or had the equivalent in years of education. All caregivers were based in the community. Overall risk of bias was high for most studies.The results demonstrated that there is probably little or no difference between telephone support interventions and usual care for the primary outcome of quality of life at the end of intervention (SMD -0.02, 95% CI -0.24 to 0.19, 4 studies, 364 caregivers) (moderate-certainty evidence) or burden at the end of intervention (SMD -0.11, 95% CI -0.30 to 0.07, 9 studies, 788 caregivers) (low-certainty evidence). For one study where quality of life at the end of intervention was reported narratively, the findings indicated that a telephone support intervention may result in slightly higher quality of life, compared with usual care. Two further studies on caregiver burden were reported narratively; one reported that telephone support interventions may decrease burden, the other reported no change in the intervention group, compared with usual care.We are uncertain about the effects of telephone support interventions on caregiver depression at the end of intervention (SMD -0.37, 95% CI -0.70 to -0.05, 9 studies, 792 caregivers) due to very low-certainty evidence for this outcome. Depression was reported narratively for three studies. One reported that the intervention may reduce caregiver depression at the end of intervention, but this effect was not sustained at short-term follow-up. The other two studies reported there may be little or no difference between telephone support and usual care for depression at the end of intervention. Six studies measured satisfaction with the intervention but did not report comparative data. All six reported high satisfaction scores with the intervention. No adverse events, including suicide or suicide ideation, were measured or reported by any of the included studies.Our analysis indicated that caregiver anxiety may be slightly reduced (MD -6.0, 95% CI -11.68 to -0.32, 1 study, 61 caregivers) and preparedness to care slightly improved (SMD 0.37, 95% CI 0.09 to 0.64, 2 studies, 208 caregivers) at the end of intervention, following telephone-only support interventions compared to usual care. Findings indicated there may be little or no difference between telephone support interventions and usual care for all of the following outcomes at the end of intervention: problem-solving, social activity, caregiver competence, coping, stress, knowledge, physical health, self-efficacy, family functioning, and satisfaction with supports (practical or social). There may also be little or no effect of telephone support interventions for quality of life and burden at short-term follow-up or for burden and depression at medium-term follow-up.Litttle or no difference was found between groups for any of the reported outcomes in studies comparing telephone and non-telephone professional support interventions. We are uncertain as to the effects of telephone support interventions compared to non-telephone support interventions for caregiver burden and depression at the end of intervention. No study reported on quality of life or satisfaction with the intervention and no adverse events were reported or noted in the two studies reporting on this comparison. AUTHORS' CONCLUSIONS: Although our review indicated slight benefit may exist for telephone support interventions on some outcomes (e.g. anxiety and preparedness to care at the end of intervention), for most outcomes, including the primary outcomes, telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care. The findings of the review were mainly based on studies with overall high risk of bias, and few participants. Further high-quality trials, with larger sample sizes are required

Defining and researching the concept of resilience in LGBT+ later life : findings from a mixed study systematic review

Within the literature, resilience is described as either a trait, an outcome or a process and no universal definition exists. A growing body of research shows that older LGBT+ adults show signs of resilience despite facing multiple inequalities that negatively impact their health and social wellbeing. The aim of this review was to examine how resilience is defined in LGBT+ ageing research and how it is studied. A mixed-study systematic search of peer-reviewed research papers published before June 2022 was conducted using the electronic databases CINAHL, Embase, Medline, PsycInfo, Social Science Database and Web of Science. This resulted in the screening of 7101 papers 27 of which matched the inclusion criteria. A quality appraisal was conducted using the Mixed Methods Appraisal Tool. Findings show that papers often lack a clear definition of resilience and application of resilience theory within the studies, although many of the papers conceptualised resilience as either a trait, process or an outcome. However, resilience was rarely the primary focus of the studies and was researched using a variety of measurement instruments and conceptual frameworks. Given the socioeconomic disparities, diverse social relations, histories of discrimination and stigma, and acts of resistance that have shaped the lives of older LGBT+ populations, resilience is a topic of growing interest for researchers and practitioners. Clear definitions of resilience and application of resilience theory could help improve methods used to study the concept and lead to more robust findings and the development of effective interventions. Greater clarity on the concept of resilience could also broaden the focus of research that informs policies and practice, and support practitioner training in resilience and the particular experiences of older LGBT+ adults

Exploring the concept of resilience in older LGBT+ people : a mixed study systematic review

[Abstract not available

Educating health and social care practitioners on the experiences and needs of older LGBT+ adults: Findings from a systematic review

Aim(s): To report review findings into interventions used to educate the health and social care workforce on the experiences and needs of LGBT+ older adults. Background: Research demonstrates that inequalities in outcomes on health and social well-being for LGBT+ older adults are perpetuated by the cumulative disadvantages from discrimination and social exclusion throughout the life course and a lack of culturally competent workforce. Methods: A systematic search of peer-reviewed papers published before February 2020 was conducted in electronic databases. The search resulted in a screening of 2,509 papers with nine matching the inclusion criteria, which were rated using the MERSQI quality measure. Results: Studies demonstrated some positive outcomes of interventions, especially an increase in knowledge, but less so in skills and attitudes. Discussion: More robust designs such as randomized controlled trials, the use of standardized measures and a focus more on the longitudinal impact of educational interventions could improve the quality of study designs. Conclusion(s): Diversification of intervention content and patient and public involvement in the design, delivery and evaluation of educational interventions could improve efforts and have a more sustained impact on LGBT+ ageing inequalities. Implications for Nursing Management: Nurse managers have important roles in supporting staff education and ensuring LGBT+ inclusive practice

Evidence-based clinical practice guidelines for prevention, screening and treatment of peripartum depression

Background Peripartum depression (PPD) is a prevalent mental health disorder in the peripartum period. However, a recent systematic review of clinical guidelines relating to PPD has revealed a significant inconsistency in recommendations. Aims This study aimed to collect up-to-date evidence on the effectiveness of interventions and provide recommendations for prevention, screening and treating PPD. Method A series of umbrella reviews on the effectiveness of PPD prevention, screening and treatment interventions was conducted. A search was performed in five databases from 2010 until 2023. The guidelines were developed according to the GRADE framework and AGREE II Checklist recommendations. Public stakeholder review was included.Results One hundred and forty-five systematic reviews were included in the final analysis and used to form the guidelines. Forty-four recommendations were developed, including recommendations for prevention, screening and treatment. Psychological and psychosocial interventions are strongly recommended for preventing PPD in women with no symptoms and women at risk. Screening programmes for depression are strongly recommended during pregnancy and postpartum. Cognitive-behavioural therapy is strongly recommended for PPD treatment for mild to severe depression. Antidepressant medication is strongly recommended for treating severe depression in pregnancy. Electroconvulsive therapy is strongly recommended for therapy-resistant and life-threatening severe depression during pregnancy. Other recommendations are offered to healthcare professionals, stakeholders and researchers in managing PPD in different contexts. Conclusion Treatment recommendations should be implemented after carefully considering clinical severity, previous history, risk-benefit for mother and foetus/infant and women's values and preferences. Implementation of evidence-based clinical practice guidelines within country-specific contexts should be facilitated.</p

Mapping barriers, enablers and implementation determinants to shared models of care for physical health and sexual wellbeing among young people with mental health difficulties using the Consolidated Framework for Implementation Research: A scoping review protocol [version 2; peer review: 2 approved]

Background Approximately one in eight people live with mental health difficulties, with onset commonly occurring in youth. It is critical to ensure care addresses all aspects of health, including physical health and sexual wellbeing needs, to achieve positive recovery outcomes. Connecting primary and secondary healthcare providers and service users through shared models of care is a critical aspect of this. The objectives of this scoping review will be to 1) identify and describe the implementation of shared models of care which address the mental health of young people and their physical health and/or sexual wellbeing needs, and 2) identify the determinants of implementing these models of care. Protocol Following Joanna Briggs Institute guidelines, studies will be included if they describe shared models of care for young people (aged 10–25) in any healthcare setting, specifically addressing mental health and physical health or sexual wellbeing needs. The review will employ the Consolidated Framework for Implementation Research (CFIR) to organise and assess findings. A librarian developed the search strategy, which will be applied to Web of Science, Medline, Embase, CINAHL, and PsycINFO databases. Two independent reviewers will screen titles, abstracts and full texts, followed by data extraction and critical appraisal of included studies. Discrepancies at all stages will be resolved through discussion or by a third reviewer. Screening results will be summarised in a PRISMA flow diagram. Narrative summaries, supported by tables and figures where applicable, will address the review’s objectives. Findings will undergo thematic analysis, with implementation determinants mapped deductively to CFIR. Discussion Findings will inform the adaptation of implementation strategies to support the implementation of policy for improving healthcare delivery to young people with mental health difficulties. Registration Open Science Framework (osf.io/rj783)

Scoping Review of Quality Improvement Efforts for Trauma-Informed Care In Low-Middle Income Countries

This is a protocol for a scoping review that aims to understand the overlap in Quality Improvement efforts and Trauma-Informed Care in low and middle income countries. References for included citations: https://drive.google.com/file/d/1-bya-uiI1bCJb27_T6yx60orMS0ssvdG/view?usp=drive_link