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. 2021 Apr;77(4):1667-1682.
doi: 10.1111/jan.14696. Epub 2020 Dec 7.

Caregiver autonomy support: A systematic review of interventions for adults with chronic illness and their caregivers with narrative synthesis

Michael A Stawnychy  1   2 , Anne M Teitelman  3 , Barbara Riegel  2   4   5
Affiliations

Caregiver autonomy support: A systematic review of interventions for adults with chronic illness and their caregivers with narrative synthesis

Michael A Stawnychy et al. J Adv Nurs. 2021 Apr.

Abstract
in English, Chinese

Chronic illnesses cause significant mortality in adults. Caregivers (spouses, adult children, friends) support adults with chronic illness in multiple ways, for instance through support of their autonomous decisions about how and why to engage in self-care.

Aim: To examine interventions designed to improve the health and well-being of adults with chronic illness by enhancing the autonomy supportive behaviours of caregivers.

Design: Systematic review of randomized controlled trials with narrative synthesis.

Data sources: All available dates of publication through August 2020 conducted in PubMed, Medline, Ageline, PsychInfo, and CINAHL.

Methods: Randomized controlled interventions of adults with chronic illness and their caregivers with content to enhance caregiver autonomy support were included. Interventions involving healthcare personnel, adults without self-care capacity, or not published in English were excluded. Quality was appraised using Joanna Briggs Institute recommendations. Common themes in autonomy support and associated outcomes (e.g., self-care, social support) were synthesized.

Results: Search identified 1,426 studies with 16 included in review (N = 2,486 dyads). Methodological quality was moderate. Successful interventions were skills-based, targeted various communication styles, contained in-person elements, and involved nurses. Half of the interventions assessed autonomy support outcomes; 63% (5 of 8) of these improved autonomy support. Results were generally positive for social support, mixed for self-care, and null for caregiver burden. Heterogeneity and complexity of studies limited attribution of effects.

Conclusion: Behavioural interventions designed to enhance dyadic caregiver interpersonal communication to be autonomy supportive may positively influence caregiver skills and chronic illness outcomes. Future studies of autonomy support are needed to identify core intervention components.

Impact: This is the first systematic review examining interventions promoting caregiver to care-receiver autonomy support. Modifying interpersonal communication to be autonomy supportive has potential to improve chronic illness outcomes. Findings can inform how clinicians and investigators enlist caregiver autonomy support to encourage behaviour change.

慢性病导致成年人死亡率显著增加。照料人员 (配偶、成年子女、朋友) 以多种方式支持患有慢性病的成年人, 例如支持他们自主决定如何进行自我照顾以及自我照顾的原因。 目的: 研究旨在通过加强照料人员自主支持行为来改善患有慢性病的成年人的健康福祉的干预措施。 设计: 随机对照试验的系统化评估和叙述性综合。 数据来源: 截至2020年8月在PubMed、Medline、Ageline、PsychInfo和CINAHL发布的所有出版物的可用日期。 方法: 纳入了对患有慢性病的成年人及其照料人员的随机对照干预 (干预旨在加强照料人员自主性支持) 。排除了涉及医疗服务提供者、无自理能力的成人或未用英文发表的干预。采用乔安娜·布里格斯研究所的建议, 对质量进行评估。综合了自主性支持和相关结果 (如自我照顾、社会支持) 的共同主题。 结果: 检索确定了1,426项研究, 其中16项纳入评估 (N=2,486对) 。方法学质量适宜。成功的干预措施以技能为基础, 针对不同的沟通方式, 包含个人要素, 并且涉及护士参与。半数干预措施对自主支持结果进行了评价; 其中63%(5/8) 的干预措施改善了自主支持。研究结果是普遍对社会支持持肯定态度, 对自我护理持综合态度, 对照料人员负担持否定态度。研究的异质性和复杂性限制了效应的归因。 结论: 行为干预旨在加强双人照料人员的人际沟通, 使其具有自主支持, 这可能会对照料人员的技能和慢性病结果产生积极影响。今后需要对自主支持进行研究, 以确定核心干预内容。 影响: 这是首次系统化评估, 研究了促进照料人员对被照料人员自主支持的干预措施。将人际沟通变更为自主支持有可能改善慢性病结果。研究结果可以为临床医生和调查人员寻求照料人员自主支持以鼓励行为改变提供参考。.

Keywords: adult; autonomy support; caregiver; chronic disease; narrative synthesis; nurses; personal autonomy; randomized controlled trials; self-care; self-determination; systematic review.

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