A systematic review of psychotherapy for persons receiving palliative and hospice care, their caregivers, and patient-caregiver dyads

Background: Patients receiving palliative or hospice care and their caregivers frequently experience depression, anxiety, hopelessness, and fear of death. While previous reviews sought to clarify the impact of psychotherapy interventions for individuals receiving palliative and hospice care, none focused on the impact of psychotherapeutic interventions delivered by mental health professionals with formal psychotherapy training to all populations impacted. The aim of the present study was to systematically review the literature evaluating the efficacy of various psychotherapeutic interventions administered by mental health professionals, delivered to patients, their caregivers, and patient-caregiver dyads targeting a diverse set of outcomes.

Methods: We conducted a systematic review of the literature to examine specific forms of psychotherapy support delivered by mental health professionals with formal psychotherapy training, assessed by validated quantitative instruments, offered to patients receiving palliative or hospice care, their caregivers, and patient-caregiver dyads. Risk of bias was assessed by either the Cochrane risk of bias assessment for randomized-controlled trials (RCTs), or the Newcastle-Ottawa Quality Assessment Form for Cohort studies for pilot/feasibility studies.

Results: Twenty-seven studies met the criteria for inclusion in our final review after title/abstract and full-text screening. A wide variety of psychotherapeutic modalities and clinical outcomes were captured. Existential-phenomenological and life review/memory specificity therapy had the strongest current evidence base. Studies of cognitive behavioral therapy and dignity therapy (DT) almost uniformly found no significance in outcomes.

Conclusions: While often well-tolerated and appreciated, psychotherapy administered by mental health professionals with formal psychotherapy training inconsistently improves objective outcomes for patients receiving palliative care, their caregivers, and patient-caregiver dyads—a demographic uniquely impacted by advanced disease states and subsequent existential distress. Studies that utilized mixed-effect model intention-to-treat analyses to account for loss to follow-up and blinding approaches like delayed intervention for control groups were rated as high quality.