What is the problem?
Caring for a person with dementia often has a negative impact on an informal carer’s mental and physical health and social life. Therefore, these informal carers should be offered support. They are usually family members and care for the person with dementia at home.
What is telephone counselling?
Eliciting a person’s concerns, listening, and providing support, information, or teaching in response to a persons’s stated concerns, over the telephone.
The purpose of this review
The aim of this review was to investigate whether telephone counselling is an effective way of reducing symptoms of depression and other stresses in the carers of people with dementia. We also investigated which aspects of telephone counselling the people who received it thought could be improved.
Results of the review
We searched for scientific studies that compared telephone counselling with no treatment, or usual care or friendly calls. We found nine studies that investigated how well telephone counselling worked (efficacy) and two studies that examined the quality of the experience.
The efficacy studies investigated three types of telephone counselling: telephone counselling only (six studies); telephone counselling plus video sessions (one study); and telephone counselling plus video sessions and a workbook (two studies). These provided some evidence that telephone counselling is effective for reducing depressive symptoms in carers of people with dementia (three studies), but no clear positive effects could be shown for any other outcome such as stress or anxiety.
The studies that investigated the experience aspect of telephone counselling revealed a range of carers’ needs (16 themes) that covered three main areas: barriers to - and things that enabled - successful implementation of telephone counselling; the counsellor’s emotional attitude; and the content of the telephone counselling.
All studies were of moderate quality.
Analysis of both sets of results, i.e. efficacy compared with information about carers' experiences of telephone counselling, revealed needs that so far have not been met by telephone counselling. The studies that examined the experience aspect covered a very limited range of telephone counselling. The results of this review should be interpreted with caution due to the small number of included studies and their moderate quality.
There is evidence that telephone counselling can reduce depressive symptoms for carers of people with dementia and that telephone counselling meets important needs of the carer. This result needs to be confirmed in future studies that evaluate efficacy through robust RCTs and the experience aspect through qualitative studies with rich data.
Informal carers of people with dementia can suffer from depressive symptoms, emotional distress and other physiological, social and financial consequences.
This review focuses on three main objectives:
1) produce a quantitative review of the efficacy of telephone counselling for informal carers of people with dementia;
2) synthesize qualitative studies to explore carers’ experiences of receiving telephone counselling and counsellors’ experiences of conducting telephone counselling; and
3) integrate 1) and 2) to identify aspects of the intervention that are valued and work well, and those interventional components that should be improved or redesigned.
The Cochrane Dementia and Cognitive Improvement Group's Specialized Register, The Cochrane Library, MEDLINE, MEDLINE in Process, EMBASE, CINAHL, PSYNDEX, PsycINFO, Web of Science, DIMDI databases, Springer database, Science direct and trial registers were searched on 3 May 2011 and updated on 25 February 2013. A Forward Citation search was conducted for included studies in Web of Science and Google Scholar. We used the Related Articles service of PubMed for included studies, contacted experts and hand-searched abstracts of five congresses.
Randomised controlled trials (RCTs) or cross-over trials that compared telephone counselling for informal carers of people with dementia against no treatment, usual care or friendly calls for chatting were included evaluation of efficacy. Qualitative studies with qualitative methods of data collection and analysis were also included to address experiences with telephone counselling.
Two authors independently screened articles for inclusion criteria, extracted data and assessed the quantitative trials with the Cochrane 'Risk of bias' tool and the qualitative studies with the Critical Appraisal Skills Program (CASP) tool. The authors conducted meta-analyses, but reported some results in narrative form due to clinical heterogeneity. The authors synthesised the qualitative data and integrated quantitative RCT data with the qualitative data.
Nine RCTs and two qualitative studies were included. Six studies investigated telephone counselling without additional intervention, one study combined telephone counselling with video sessions, and two studies combined it with video sessions and a workbook. All quantitative studies had a high risk of bias in terms of blinding of participants and outcome assessment. Most studies provided no information about random sequence generation and allocation concealment. The quality of the qualitative studies ('thin descriptions') was assessed as moderate. Meta-analyses indicated a reduction of depressive symptoms for telephone counselling without additional intervention (three trials, 163 participants: standardised mean different (SMD) 0.32, 95% confidence interval (CI) 0.01 to 0.63, P value 0.04; moderate quality evidence). The estimated effects on other outcomes (burden, distress, anxiety, quality of life, self-efficacy, satisfaction and social support) were uncertain and differences could not be excluded (burden: four trials, 165 participants: SMD 0.45, 95% CI -0.01 to 0.90, P value 0.05; moderate quality evidence; support: two trials, 67 participants: SMD 0.25, 95% CI -0.24 to 0.73, P value 0.32; low quality evidence). None of the quantitative studies included reported adverse effects or harm due to telephone counselling. Three analytical themes (barriers and facilitators for successful implementation of telephone counselling, counsellor's emotional attitude and content of telephone counselling) and 16 descriptive themes that present the carers’ needs for telephone counselling were identified in the thematic synthesis. Integration of quantitative and qualitative data shows potential for improvement. For example, no RCT reported that the counsellor provided 24-hour availability or that there was debriefing of the counsellor. Also, the qualitative studies covered a limited range of ways of performing telephone counselling.