Family involvement interventions on fear of cancer recurrence management among women with breast cancer and their caregivers : a systematic review and meta-analysis

Abstract

Background: 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. Objective: 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. Method: 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. Results: 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. Conclusions: 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.