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Study flow diagram. RCT: randomised controlled trial.
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Figure 1

Study flow diagram. RCT: randomised controlled trial.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Summary of findings for the main comparison. Interventions to help support caregivers of people with a brain or spinal cord tumour

Interventions to help support caregivers of people with a brain or spinal cord tumour

Patient or population: caregiver well‐being
Setting: any
Intervention: supportive interventions
Comparison: any control condition

Outcomes

Impact

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Caregiver psychological distress
assessed with: DASS‐21; Fear of Recurrence Questionnaire – Family Member; CES‐D; POMS; STAI; HADS

Follow‐up: range 1 days to 8 months

4 studies found improvements after the intervention (early palliative care; interactive‐educational programme; electronic social network intervention; self‐management programme); 1 found no significant effects (e‐mental health); 1 only reported descriptives (cognitive rehabilitation and problem‐solving).

(6 RCTs)

⊕⊕⊝⊝
Lowa,b,c,d,e

Caregiver burden
assessed with: MBCB Scale; Zarit Caregiver Burden Scale

Follow‐up: range 6 weeks to 3 months

2 studies found no statistically significant differences in burden scales between the intervention and control groups (early vs delayed palliative care; electronic social network intervention).

(2 RCTs)

⊕⊕⊝⊝
Lowe

Caregiver mastery
assessed with: Caregiver Mastery Scale; General Self‐Efficacy Scale; Utrecht Coping List

Follow‐up: range 6 months to 8 months

1 study found improvements in mastery after the intervention (psychoeducation and cognitive behavioural therapy) compared to care‐as‐usual, corrected for changes in patient functioning. 1 study found no improvements in self‐efficacy or coping strategies (self‐management programme).

(2 RCTs)

⊕⊝⊝⊝
Very lowd,e,f,g

Quality of patient–caregiver relationship
assessed with: McMaster Family Assessment Device

1 study found no statistically significant differences in family functioning between the intervention and control groups (e‐mental health vs waiting list).

(1 RCT)

⊕⊝⊝⊝
Very lowe,h

Caregiver quality of life
assessed with: SF‐36; QoL – Family Caregiver Tool; CQOLC; LASA

Follow‐up: range 30 days to 8 months

2 studies found improvements in QoL over time in the intervention group (psychosocial intervention; self‐management programme) compared to the control group; 1 study found stable QoL in the intervention group vs decline in the control group (no longer statistically significant after controlling for patient functioning); 2 studies found no statistically significant improvements after the intervention (e‐mental health; early palliative care); 1 only reported descriptives (cognitive rehabilitation and problem‐solving).

(6 RCTs)

⊕⊝⊝⊝
Very lowa,b,c,e,g,i

Caregiver physical functioning – not measured

None of the included studies assessed caregiver physical functioning.

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*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CQOLC: Caregiver QoL Index – Cancer; CES‐D: Center for Epidemiological Studies Depression Scale; CI: confidence interval; DASS‐21: Depression, Anxiety and Stress Scales; HADS: Hospital Anxiety and Depression Scale; LASA: Linear Analogue Self‐Assessment; MBCB: Montgomery‐Borgatta Caregiver Burden; POMS: Profile of Mood States; RCT: randomised controlled trial; SF‐36: 36‐item Short Form; STAI: State‐Trait Anxiety Inventory.

GRADE Working Group grades of evidence
High certainty : we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty : we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty : we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

aDifferent populations (e.g. mixed cancer caregiver samples, paediatric or adult (or both) caregiver samples).
bDifferent interventions.
cOne quasi‐RCT included.
dOutcomes measure similar constructs but do not completely overlap.
eSmall number of neuro‐oncology caregivers.
fOnly long‐term effects reported (six to eight months post baseline).
gHigh attrition, analysed using last observation carried forward in one study.
hOnly included parents of children with brain tumours.
iOne study with inadequate sequence generation and allocation concealment.

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Summary of findings for the main comparison. Interventions to help support caregivers of people with a brain or spinal cord tumour
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