Family caregivers provide substantial care for patients with advanced cancer, while suffering from hidden morbidity and unmet needs. The objectives of this review were to examine risk factors associated with caregiving for patients with advanced cancer, evaluate the evidence for pertinent interventions, and provide a practical framework for palliative care of caregivers in oncology settings. We reviewed studies examining the association of factors at the level of the caregiver, patient, caregiver-patient relationship, and caregiving itself, with adverse outcomes. In addition, we reviewed randomized controlled trials of interventions targeting the caregiver, the caregiver-patient dyad, or the patient and their family. Risk factors for adverse mental health outcomes included those related to the patient's declining status, symptom distress, and poor prognostic understanding; risk factors for adverse bereavement outcomes included unfavorable circumstances of the patient's death. Among the 16 randomized trials, the most promising results showed improvement of depression resulting from early palliative care interventions; results for quality of life were generally nonsignificant or showed an effect only on some subscales. Caregiving outcomes included burden, appraisal, and competence, among others, and showed mixed findings. Only three trials measured bereavement outcomes, with mostly nonsignificant results. On the basis of existent literature and our clinical experience, we propose the CARES framework to guide care for caregivers in oncology settings: Considering caregivers as part of the unit of care, Assessing the caregiver's situation and needs, Referring to appropriate services and resources, Educating about practical aspects of caregiving, and Supporting caregivers through bereavement. Additional trials are needed that are powered specifically for caregiver outcomes, use measures validated for advanced cancer caregivers, and test real-world interventions.

中文翻译：

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家庭照顾者的姑息治疗

家庭护理人员为晚期癌症患者提供大量护理，同时遭受隐藏的发病率和未满足的需求。本综述的目的是检查与晚期癌症患者护理相关的风险因素，评估相关干预措施的证据，并为肿瘤学环境中护理人员的姑息治疗提供实用框架。我们回顾了研究在看护者、患者、看护者与患者的关系以及看护本身的层面上检查因素与不良结果之间的关联的研究。此外，我们还审查了针对照料者、照料者-患者二人组或患者及其家人的干预措施的随机对照试验。不良心理健康结果的危险因素包括与患者状态下降、症状困扰、对预后的理解不佳；不利的丧亲结果的风险因素包括患者死亡的不利情况。在 16 项随机试验中，最有希望的结果显示早期姑息治疗干预导致抑郁症得到改善；生活质量的结果通常不显着或仅对某些子量表有影响。护理结果包括负担、评估和能力等，并显示出不同的结果。只有三项试验测量了丧亲的结果，结果大多不显着。在现有文献和我们的临床经验的基础上，我们提出了 CARES 框架来指导肿瘤学环境中的护理人员的护理：将护理人员视为护理单位的一部分，评估护理人员的情况和需求，参考适当的服务和资源，就护理的实际方面进行教育，并通过丧亲之痛支持护理人员。需要额外的试验，专门针对护理人员的结果，使用针对晚期癌症护理人员验证的措施，并测试真实世界的干预措施。