A meta-synthesis of experiences of caregivers of people with COPD

COPD is a serious health problem worldwide that is characterized by respiratory symptoms, such as breathlessness, abnormal sputum, and cough accompanied by other general symptoms, like weight loss, fatigue, anxiety, panic, and depression.1 The progression of the disease worsens the functional status and increases the dependency of people with COPD on others in the final years.2 Caregivers of people with COPD provide personal care, psychological, and emotional support, and help in managing the medications and the disease exacerbations.3 Various literature reviews have highlighted the critical aspects of caring for a person with COPD, but no systematic review of qualitative studies has been carried out to synthesize the experiences of taking care of a person with COPD.

To identify, critically appraise and synthesize the qualitative literature on the experiences of caregiving for a person with COPD
 

A qualitative meta-synthesis according to the Joanna Briggs Institute (JBI)4 method was carried out. This method, defined as meta-aggregation, is aimed at producing evidence on a specific topic to inform clinical practice. It uses a three-step process: in the first step, the findings of primary qualitative studies, represented by themes, metaphors, or concepts as reported by the original study authors, are identified; in the second step, categories are extracted from these findings based on similarity in meanings; in the last step the extracted categories are aggregated to form a set of synthesized findings, that can be used to generate recommendations for practice. Databases explored were PubMed, CINHAL, Scopus, EMBASE, Web of Knowledge, and PsycINFO, from January 1995 to August 2016, searching for articles in English. The specific Qualitative Assessment and Review Instrument (QARI) software created by the JBI was used to guide the review process. The quality of the studies was assessed trough the Critical Appraisal tool of QARI. The evidence of the study finding was classified as unequivocal, credible, unsupported. Only the findings classified by reviewers as unequivocal and credible were included in the synthesis
 

Seventeen studies met the inclusion criteria and no study was excluded based on the critical quality appraisal. Eleven categories and three synthesized findings were identified from the ninety-five findings extracted from the studies and classified as unequivocal or credible for the quality of evidence. The caregiving can be considered as a dynamic and evolving process that requires the assumption of new roles and responsibilities, and lead to a continuous adaptation to the disease changes. The support provided by the social and the healthcare services influences the caregiving process; moreover, caregiving is an all-absorbing experience that affects all the aspects of caregiver’s life.
 

The results of this review provide important indications for nursing practice. Nurses should consider the caregivers of people with COPD as partners in the caring process and should more actively involve them in the disease management. Education of caregivers should be aimed at improving their knowledge and skills on the disease, increasing their competence, and consequently diminishing uncertainty during the caring process. For example, education could focus on breathlessness and other symptom management strategies, early detection of exacerbations, management of medications and equipment with the aims to reduce episodes of hospitalizations, delay the onset of disease symptoms, and improve the patient quality of life. Moreover, information should be provided on the availability of facilities and rehabilitative services, caregiver support groups, and financial resources. In addition, the caregivers should also be considered as the subject of care by nurses. Caregivers need psychological support and encouragement by nurses to prevent burden, stress and depression, and social isolation. It is also important that nurses help caregivers find meaning in their caregiver role, identifying their strength, motivation, and sources of personal and relational empowerment.