The effect of caregiver-facilitated pain management interventions in hospitalized patients on patient, caregiver, provider and health system outcomes: A systematic review.

CONTEXT: Alternative pain management interventions involving caregivers may be valuable adjuncts to conventional pain management interventions.

OBJECTIVE: Use systematic review methodology to examine caregiver-facilitated pain management interventions in a hospital setting and whether they improve patient, caregiver, provider or health system outcomes.

METHODS: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from inception to April 2020. Original research on caregiver-facilitated pain management interventions in hospitalized settings (i.e., any age) were included and categorized into three caregiver engagement strategies: inform (e.g., pain education), activate (e.g., prompt caregiver action), and collaborate (encourage caregiver's interaction with providers).

RESULTS: Of 61 included studies, most investigated premature (n=27/61, 44.3%) and full-term neonates (n=19/61, 31.1%). Interventions were classified as: activate (n=46/61, 75.4%), inform-activate-collaborate (n=6/61, 9.8%), inform-activate (n=5/61, 8.2%), activate-collaborate (n=3/61, 4.9%), or inform (n=1/61, 1.6%) caregiver engagement strategies. Interventions that included an activate engagement strategy improved pain outcomes in adults (18-64 years)(e.g., self-reported pain, n=4/5, 80%) and neonates (e.g., crying, n=32/41, 73.0%), but not children or older adults (≥65 years). Caregiver outcomes (e.g., pain knowledge) were improved by inform-activate engagement strategies (n=3/3). Interventions did not improve provider (e.g., satisfaction) or health system (e.g., hospital length of stay) outcomes. Most studies were of low (n=36/61, 59.0%) risk of bias.

CONCLUSIONS: Caregiver-facilitated pain management interventions using an activate engagement strategy may be effective in reducing pain of hospitalized neonates. Caregiver-facilitated pain management interventions improved pain outcomes in the majority of adult studies, however the number of studies of adults is small warranting caution pending further studies.