• Morag Farquhar, Clarissa Penfold, Fiona M Walter, Isla Kuhn, and John Benson.
• Department of Public Health & Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom; School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom. Electronic address: mcf22@medschl.cam.ac.uk.
• J Pain Symptom Manage. 2016 Jul 1; 52 (1): 117-130.e27.

ContextEducating carers about symptom management may help meet patient and carer needs in relation to distressing symptoms in advanced disease. Reviews of the effectiveness of carer interventions exist, but few have focused on educational interventions and none on the key elements that comprise them but which could inform evidence-based design.ObjectivesTo identify the key elements (structural components, processes, and delivery modes) of educational interventions for carers of patients with advanced disease.MethodsWe systematically searched seven databases, applied inclusion and exclusion criteria, conducted quality appraisal, extracted data, and performed a narrative analysis.ResultsWe included 62 articles related to 49 interventions. Two main delivery modes were identified: personnel-delivered interventions and stand-alone resources. Personnel-delivered interventions targeted individuals or groups, the former conducted at single or multiple time points, and the latter delivered as series. Just more than half targeted carers rather than patient-carer dyads. Most were developed for cancer; few focused purely on symptom management. Stand-alone resources were rare. Methods to evaluate interventions ranged from postintervention evaluations to fully powered randomized controlled trials but of variable quality.ConclusionPublished evaluations of educational interventions for carers in advanced disease are limited, particularly for non-cancer conditions. Key elements for consideration in developing such interventions were identified; however, lack of reporting of reasons for nonparticipation or dropout from interventions limits understanding of the contribution of these elements to interventions' effectiveness. When developing personnel-delivered interventions for carers in advanced disease, consideration of the disease (and, therefore, caring) trajectory, intervention accessibility (timing, location, and transport), and respite provision may be helpful.Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

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