Family Caregiver Needs, Interventions, and Outcomes in Home-Based Cancer Palliative Care: A Scoping Review

Abstract

Background

Family caregivers play a pivotal role in supporting patients with advanced illness throughout palliative care. However, the burden of care often exceeds their capacity, highlighting the need for supportive interventions.

Purpose

This review aimed to (1) identify the needs of family caregivers in palliative care settings, (2) describe the types and characteristics of intervention models implemented to support caregivers, and (3) synthesize the reported benefits of these interventions.

Methods

A scoping review was conducted following the PRISMA-ScR guideline. Relevant articles were retrieved from EBSCO-host, PubMed, Cochrane, and Scopus using keywords related to “family caregiver”, “palliative care”, “intervention”, and “support”. Inclusion criteria comprised peer-reviewed studies reporting caregiver-focused interventions in palliative care. Data were charted and categorized into caregiver needs, intervention types, and benefit outcomes.

Results

A total of 15 studies met the inclusion criteria. Caregivers’ key needs centered on emotional support, knowledge to provide physical care, psychological resilience, and navigation of healthcare systems. Intervention models varied, including psychoeducational programs, mindfulness-based support, communication tools, and digitally delivered services. The benefits of these interventions clustered into four main areas: physical (eg, symptom management knowledge), psychosocial-spiritual (eg, anxiety reduction, emotional coping, existential well-being), quality of life (eg, empowerment, improved HRQoL), and feasibility (eg, acceptability, implementation barriers). While several interventions demonstrated significant positive effects, others yielded mixed or non-significant results depending on delivery method and context.

Conclusion

Family caregivers have multidimensional needs that can be addressed through tailored palliative care interventions. Future programs should prioritize flexible, context-adapted models to optimize impact and caregiver outcomes across domains.

Introduction

Increasing global life expectancy accompanied by high rates of chronic disease worldwide is often found to increase the complexity of health care and increase the fulfilment of the need for palliative care.¹ Unfortunately, it is estimated that more than 35 million people with life-limiting illnesses worldwide do not receive appropriate palliative care.² Cancer is a non-communicable chronic disease which is the main cause of death worldwide with the number of death cases reaching 10 million people in 2020.³ Advanced cancer patients often request discharge to receive palliative care at home and spend more time with their families towards the end of their lives.^4,5 Home-based palliative care that centers family caregivers enhances quality of life, eases symptom and decision-making burdens, and reduces preventable hospital use, key steps toward good health and well-being at the household and community level. By prioritizing access, equity, and dignity near the end of life, it helps close gaps for vulnerable households and strengthens people-centered primary care.

There are several models of palliative home-based care that can be applied, one of which is person-centered and integrated chronic heart failure and palliative home care (PREFER).⁶ In addition, there is also a home-based palliative care (HBPC) model that requires complex collaboration between doctors and nurse specialists and generalists, palliative organizations, physiotherapists, social services, and patients’ families to provide care that applies the FCC (family centered care) concept.^7,8

The treatment of palliative patients at home is concerned about affecting the people closest to the patient, particularly family in terms of the fulfilment of palliative care at home.⁹ According to the data from the National Alliance for Caregiving (NAC), there are at least more than 40 million adults in the United States who act as family caregivers (FCG) and cancer is one of the main reasons why FCG is needed.¹⁰

Partners, relatives or friends as FCGs play an important role in providing long-term care by carrying out numerous tasks that are physically, socially, emotionally and financially hard duties.^11,12 Increasingly complex caregiving tasks including assistance with activities of daily living (ADL), coordinating and attending hospital appointments, managing and providing home medical care, and assisting decision making are often reported to increase the burden of FCG caring for palliative patients with advanced disease.¹³ Although parenting can be associated with positive outcomes, including post-traumatic growth, increased personal power, and closer spousal relationships with families¹⁴ it may also trigger some negative consequences for FCG.¹⁵ Based on several previous studies, sleep disturbances, weight loss, fatigue, and an increased incidence of mental disorders are problems that are often reported.^16,17 As the family’s need for palliative care support at home grows, it is important to provide support for FCG in caregiving palliative cancer patients at home.

Unfortunately, providing support to FCGs is often considered an under-recognized priority.¹⁸ This is supported by the results of a survey in a developed country in Europe which stated that only 50% of FCG received adequate support during the last 3 months of their family members’ lives.¹⁹ Until now, the aspect of fulfilling FCG needs as part of a unit in palliative care is still an urgency as well as a challenge for health service providers.²⁰

Over the past few years, various patient- and family-focused models of palliative care have been developed in many countries.^7,21–23 In addition, there are certain interventions specifically aimed at providing support for families by increasing FCG ability to make decisions, readiness to care for palliative patients and carry out pain management.^8,21 However, to our knowledge, there were limited studies discussing comprehensively on family-focused palliative care at home. The previous review studies related to the integration of palliative care in outpatient and home settings did not focus on FCG in caregiving for cancer patients.²³

Demand for home-based palliative care is global, evidence on its effectiveness originates predominantly from high-income countries where coverage reaches up to 81%, whereas in low- and middle-income countries where an estimated 16.4 million people died with serious health-related suffering in 2015 coverage is only 10–37% and evidence on implementation remains scarce, despite evidence that home-based palliative care enhances quality of life, reduces hospitalizations, and increases likelihood of dying in preferred settings when supported by multidisciplinary teams and caregiver support.^24,25

Therefore, this review broadly aims to explore the landscape of palliative care interventions that support family caregivers (FCGs) in home settings, particularly in the context of cancer care. More specifically, the review seeks to: (1) identify the needs of family caregivers in home-based palliative care, (2) describe the intervention models developed to address those needs, and (3) synthesize the reported benefits of these interventions in empowering caregivers to provide effective care at home.

Materials and Methods

This scoping review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.²⁶

Information Source and Searching Strategy

This study uses electronic databases from EBSCO-host, PubMed, Cochrane, and Scopus. All of these databases were selected because they are relevant to the research question and can provide broad and focused coverage of relevant literature. In conducting the search, several steps were taken to minimize potential bias. It began with developing a PCC (Population, Concept, and Context) framework to determine the scope of the search, to ensure that all aspects of the research question could find relevant studies to consider. The Population (P) in this study was family caregivers. The Concept (C) included the concept of palliative care provided by caregivers who had family members with cancer, while the Context (C) consisted of various home-care-based palliative care service models. The PCC components were then translated into relevant keywords and MeSH terms. The keywords used were Caregiver OR “Family Caregiver” OR “Caregiver” OR “Spouse Caregiver” AND “Palliative Care” OR “Hospice Care” OR “Palliative Treatment” OR “Palliative Supportive Care” OR “Palliative Medicine” OR “Terminal Care” AND “Home Care” OR “Home Care Service” OR “Home Health Care” OR “Home Healthcare” OR “Home-based Care”. Synonyms are also used to retrieve all possible relevant articles by using Boolean operators “AND” and “OR” to trim or expand the search results. The literature search was conducted between August to September 2025. The search strategy used in this study for each database can be seen in (Table S1).

Eligibility Criteria

To minimize potential bias in determining which studies to include, inclusion and exclusion criteria were established based on the PCC framework relevant to the research question.

Inclusion Criteria

This review included studies involving family caregivers (FCGs) aged ≥18 years who provided informal (unpaid) care at home for adult cancer patients. The review focused on studies that evaluated palliative care interventions aimed at supporting these caregivers. Palliative care was defined broadly to include physical, psychological, educational, spiritual, or decision-making support delivered through structured programs, such as training, counselling, communication enhancement, or digital tools. Studies were included if the intervention was delivered in home-based care settings, such as domiciliary palliative care, home hospice programs, or outpatient services intended for use in the patient’s residence. The studies included in this review are those published in the last 10 years (January 2015 to August 2025).

Exclusion Criteria

Studies were excluded if they: (1) focused on caregivers of paediatric patients or on professional/paid caregivers; (2) non palliative programs; (3) were conducted entirely within institutional or inpatient settings without a home-based component; (4) lacked a structured intervention component, such as descriptive surveys or needs assessments without evaluation; (5) were not primary research studies, including systematic reviews, commentaries, editorials, protocols, or conference abstracts; (6) were not available as full-text articles or were not published in English; or (7) were published before 2015, as earlier studies may not reflect current palliative care practices, family-centered caregiving approaches, or updated clinical guidelines that have evolved significantly in the past decade.

Study Selection

After searching the database, a duplication check was performed to ensure that no studies were replicated. Then, two reviewers (TAU and KI) independently screened the titles and abstracts based on the established inclusion criteria. After that, relevant studies were comprehensively assessed based on their full text to determine whether they were eligible for inclusion. This double review was conducted to minimize the risk of selection bias by ensuring that the final inclusion of studies was based on the consistent and agreed application of criteria. In the event of a disagreement, a third and fourth reviewer (RW and NA) acted as adjudicators to mediate the difference. The entire process was conducted using Rayyan software.

Extraction and Management Data

The data extraction process was carried out by TAU and KI, while RW checked and verified the data extraction process. This process was carried out to further minimize subjective bias and errors in the data extraction process, thereby ensuring that the data included was accurate and complete. Any discrepancies or uncertainties were resolved by consensus with the third and fourth reviewers (RW and NA). Data was extracted using a predetermined extraction table and recorded manually in Microsoft Excel 2010. The data extraction process was conducted using a structured charting table to systematically collect key information from each included study. The extracted variables included author and year of publication, study design, country, characteristics of the participants (with a focus on family caregivers), type and content of the palliative care intervention, delivery format (such as face-to-face, digital, or blended), health professionals involved, intervention duration, and main outcomes. Additionally, notes on the feasibility, acceptability, and implementation challenges were documented. This process ensured that all relevant aspects of the interventions and their impact on family caregivers were captured comprehensively for further synthesis.

Data Analysis and Synthesis

A descriptive thematic analysis was applied to synthesize the findings across studies. After organizing the extracted data, the results were grouped into four thematic clusters: physical, psychosocial-spiritual, quality of life (QoL), and feasibility. Each cluster was developed based on recurring patterns in caregiver-related outcomes and intervention objectives. Studies reporting significant, mixed, or non-significant results were all included to reflect the diversity of evidence. The synthesis aimed to explore how different models of palliative care supported family caregivers at home, highlighting both the benefits and implementation considerations reported across the literature.

Quality Assessment

TAU conducted a methodological assessment of the quality of the included studies, followed by additional independent verification by KI, thereby reducing the risk of subjective bias. Any differences between reviewers were resolved through consensus with other reviewers (RW and NA). Studies were assessed using the JBI Critical Appraisal Checklist, which was adapted to the study methods of each finding.^27–29 This checklist combines specific criteria designed to evaluate various aspects of study quality, thereby minimizing bias arising from a lack of clear assessment criteria. Studies using mixed methods were assessed using the Mixed Methods Appraisal Tool.³⁰ Studies scoring higher than 70%, between 50% and 70%, and less than 50% were categorized as high, moderate, and low quality, respectively. The predefined categorization of quality scores (high, moderate, and low) based on established thresholds provides a consistent and transparent approach to interpreting assessment results, reducing potential bias in the overall quality ranking of the included studies.

Results

Study Selection

The PRISMA flow diagram showing the steps of literature selection is presented in Figure 1. A comprehensive search conducted in EBSCO-host, PubMed, Cochrane, and Scopus yielded 4.064 studies that potentially met the inclusion criteria. After the process of removing duplicates and evaluating based on titles and abstracts, 118 studies were found to be reviewed in full text. Finally, 15 studies met the inclusion criteria to be included in the review. We also added the PRISMA checklist (Table S3).

Figure 1.

PRISMA flowchart of the study selections. Adapted from Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71.

Study Characteristics

Table 1 shows the characteristics of the studies included in the analysis. A total of 2021 participants were involved in the 15 studies. Based on country characteristics, all studies were conducted in developed countries, including Sweden (n=4), United States (n=2), Denmark (n=2), and one study each in Singapore, Australia, Japan, Belgium, Canada, United Kingdom, and Spain. Most of these studies used an RCT design (n=11, 73.3%), while the remainder were feasibility (n=2), qualitative (n=1), or mixed-methods (n=1). All the studies included revealed the results of how palliative care interventions were provided to families caring for cancer patients at home.

Table 1.

Characteristics of Studies

Study	Country	Design	Recruited/Baseline/Analyzed	Sample	Key Findings
Holm et al, 20168	Sweden	RCT	270 / 270 / 194	270 FCG	Improved preparedness; no effects on anxiety/depression/burden
Luker et al, 201521	UK	Feasibility	60 / 60 / 52	60 FCG	Improved confidence and competence in home care
Leow et al, 201531	Singapore	Pilot RCT	80 / 80 / 68	80 FCG	Improved anxiety, emotional support, self-efficacy
Hudson et al, 201532	Australia	RCT	316 / 298 / 262	298 FCG	Increased preparedness; no effects on burden/distress
Ammari et al, 201833	Denmark	RCT	110 / 110 / 92	55 FCG +55 patients	No significant effects; tendency worse health in relatives
Von Heymann-Horan et al, 201834	Denmark	RCT cluster	450 / 441 / 380	190 FCG +251 patients	Feasible and acceptable dyadic intervention
Washington et al, 201835	USA	Feasibility	83 / 83 / 72	83 FCG	Feasible problem-solving therapy
Hasuo et al, 201936	Japan	RCT	54 / 54 / 51	54 FCG	Improved HRQoL and autonomic function [HRV]
Dhollander et al, 202022	Belgium	Mixed-Method	75 / 70 / 58	29 FCG +41 patients	Improved empowerment, safety, QoL
Aubin et al, 202137	Canada	RCT	120 / 109 / 97	109 FCG	Distress decreased over time, no between-group diff
Valero-Cantero et al, 202338	Spain	RCT	88 / 82 / 78	82 FCG	Reduced burden and improved QoL via music
Doveson et al, 202439	Sweden	RCT	40 / 39 / 36	39 spouses	No improvements in couple communication
Bauman et al, 2025a40	Sweden	Qualitative	32 / 32 / 32	16 FCG +16 patients	Improved illness understanding and readiness
Bauman et al, 2025b41	Sweden	RCT	243 / 205 / 168	205 FCG	No effects on preparedness; need flexible design
Mayahara et al, 202542	USA	RCT	90 / 88 / 84	44 FCG +44 patients	Reduced pain intensity, improved adherence

Main Result

Family Caregivers’ Need of Care and Support

Among the 15 included studies, several unmet needs were identified among family caregivers (FCGs) providing home-based care for cancer patients (see Table 2). These needs included care plan support,^{21,22,33,34,36,37,39,41,42} informational support,^{8,21,22,31–34,37–39,42} psychosocial support,^{8,22,31–35,37–42} and psychological-emotional support.^{8,18,21,31,33–42} Other categories included supportive care,^{8,22,31,34,37–39} practical problem-solving,^{8,22,35–37,41,42} communication,^{22,34,39–42} financial support,²² support for decision-making and coping,^33–35,39 spiritual care,^8,34 and caregiving preparedness.^{8,21,32,37,39,41} These identified needs served as the foundation for intervention development across studies. The interventions were grouped into several categories: psychological and emotional interventions,^{8,22,31,32,34,37,38,40,41} health education interventions,^{8,21,22,31,32,39,41,42} care plan support interventions,^{21,22,37,39,41,42} family coping and problem-solving interventions,^{33–35,40,41} and practical skills training for FCGs.^{21,36–38,42}

Table 2.

Family Caregiver Needs, Caregiver-Focused Interventions, Reported Caregiver Outcomes, and Critical Evaluation

Study	FCG Needs	Intervention	Benefits	Critical Evaluation
Leow et al, 201531	Psychosocial and educational support	Psychoeducational Intervention [CCP]	Reduced anxiety, emotional support, self-efficacy	Online forums poorly received; video cases useful
Luker et al, 201521	Informational support	Booklet intervention	Symptom control, physical care competence	Recruitment through district nurses difficult
Hudson et al, 201532	Psychological support	Psycho-educational intervention	Competence, preparedness	Need longer follow-up assessment
Holm et al, 20168	Preparedness, knowledge, support needs	Psycho-educational group intervention	Preparedness for caregiving	Standard support varied across settings
Ammari et al, 201833	Problem coping and information	FamCope intervention	Meaning-making and coping	Target population unclear; long duration needed
Von Heymann-Horan et al, 201834	Psychological support	Dyadic psychological intervention	Dyadic coping	Assessment not formalized
Washington et al, 201835	Psychological support	Problem-Solving Therapy	Reduced anxiety and depression	Resource availability required
Hasuo et al, 201936	Self-care management	Resonant breathing	Improved HRQoL and HRV	No long-term evaluation
Dhollander et al, 202022	Psychosocial, sexual, financial, practical support	EPHECT intervention	Empowerment, safety, QoL	Need more FCG involvement
Aubin et al, 202137	Supportive & emotional care	Nurse-led supportive intervention	Emotional support, preparedness	Possible contamination effect
Valero-Cantero et al, 202338	Psychological support	Music intervention	QoL benefits	Need cultural tailoring
Doveson et al, 202439	Communication	Web psychoeducational intervention	Conversation with spouse, QoL unchanged	No significant effect
Bauman et al, 2025a40	Symptom management and readiness	Web psychoeducational intervention narstaende.se	Knowledge and readiness	Digital access limitations
Bauman et al, 2025b41	Readiness	Web psychoeducational intervention narstaende.se 23 videos 2.5–8.5 min	Increasing knowledge about terminal illness symptoms	Needs flexible design; overall non-significant due to varying needs
Mayahara et al, 202542	Pain management	e-PainSupport	Improved pain management	Focused on caregiver education

Type of Intervention to Fulfil FCG’s Need

The interventions identified in this review varied in their aims to address family caregivers’ needs. Most focused on improving quality of life (QoL),^{21,31,33,35–38,40} and psychological outcomes such as stress,^{21,31,32,37,40} anxiety,^8,32–35,40 and depression.^{8,21,31–35,40} While, the other targeted outcomes included reducing caregiving burden,^{8,21,32,37,38,40,41} improving symptom control perception,^{21,35–37,42} self-efficacy,^21,31,38,42 caregiving preparedness,^{8,21,32,37,39,41,42} caregiving competence,^8,21,32 and closeness with patients and social support.^{31,34,37,38,40,41} Some interventions also aimed to enhance knowledge and satisfaction with care.^{8,21,22,31,32,42}

Benefit of Palliative Care for Family Caregiver

Evidence within the physical domain was limited and primarily related to caregiving competencies associated with symptom management and physical care.^8,21,22 Improvements were reported in caregiving competence and preparedness following targeted educational interventions.^8,21,32,37 However, findings related to symptom perception were less consistent. While some caregivers reported greater confidence in managing physical care needs, improvements in perceptions of patient pain and anxiety were generally not significant.^32,35,36,42

Psychosocial-spiritual outcomes constituted the largest body of evidence. Most interventions reported improvements in anxiety, emotional support, self-efficacy, psychological well-being, coping ability, or existential well-being.^{8,31–34,36,38,40,42} Psychoeducational, supportive care, mindfulness-based, and music-based interventions demonstrated beneficial effects on emotional outcomes and caregiver resilience.^{31,32,38,40,42} Nevertheless, the evidence was not uniformly positive. Several randomized trials reported no significant reductions in caregiver burden, anxiety, or depression despite structured psychosocial support programs.^33,35,37,41 Furthermore, outcomes related to preparedness and emotional coping were mixed, suggesting that intervention effectiveness may depend on factors such as timing, delivery mode, and caregiver characteristics.^{8,32,37,39,41} Although dyadic psychological interventions were generally feasible and well accepted,^34,40 formal evidence regarding their effectiveness remained limited.

QoL outcomes showed mixed findings across studies. Improvements in health-related quality of life (HRQoL), empowerment, wellbeing, and autonomic regulation were reported following psychoeducational and self-care interventions.^31,36,38,40 In particular, a self-care breathing intervention significantly improved HRQoL and heart rate variability,³⁶ while psychoeducational support enhanced caregiver empowerment and wellbeing.^31,38 However, communication-focused and technology-assisted interventions frequently failed to demonstrate significant improvements in overall QoL.^33,39,41,42 Several studies reported partial benefits, such as enhanced feelings of safety or reduced caregiver burden, without corresponding improvements in broader QoL measures.^21,22,34,37 These findings suggest that improvements in specific aspects of caregiving do not necessarily translate into measurable gains in overall quality of life.

In terms of feasibility, most interventions were considered acceptable and implementable in home-based palliative care settings.^{8,21,22,34,37,39–42} Feasibility and acceptability were consistently reported for home visits, structured supportive care programs, telehealth approaches, and caregiver-focused interventions.^{21,22,34,39,42} Nevertheless, implementation barriers were common and included recruitment challenges, limited caregiver engagement, and competing caregiving responsibilities.^{33,34,37,41,42} Participation was often constrained by time and logistical factors, while interventions that adapted delivery to local contexts reported improved uptake and engagement.

Quality Assessment

Quality assessment has been conducted, and the results show that there are no low-quality RCT, qualitative, or mixed-method studies (Table S2). Among the RCT studies, 9 studies were categorized as high and moderate quality. There was 1 quasi-experimental and qualitative study in the high-quality category, while 3 other mixed-method studies were categorized as high quality.

Discussion

The synthesis of findings from this scoping review highlights the variability in outcomes of home-based palliative care interventions aimed at supporting and empowering FCG. Findings regarding caregiver burden, psychological distress, and preparedness were mixed, with several studies reporting significant improvements while others showed limited or non-significant effects.^{8,32,33,35,37} Nevertheless, several studies reported meaningful improvements in psychological well-being, quality of life, coping ability, and caregiving readiness, especially where psycho-educational, problem-solving, and supportive care planning interventions were implemented.^{8,21,22,31,34,36,43–45}

In terms of benefits, psychological and emotional support consistently emerged as a central and recurring need. FCGs often assume extensive care responsibilities at home with little preparation, which exposes them to anxiety, depression, fatigue, and neglect of self-care.⁴⁶ Several problem-solving and psychological support interventions were associated with improvements in distress, anxiety, coping, or quality of life; however, findings were inconsistent across studies, and significant reductions in caregiver burden and depression were not uniformly observed.^35,37,44,45 Evidence from the broader palliative care literature suggests that meaning-centered psychotherapy may improve spiritual well-being and quality of life; however, the family-centered intervention included in this review did not demonstrate consistent psychosocial benefits.^34,47

Psycho-educational and supportive care planning interventions added another layer of benefit by improving preparedness, decision-making, and symptom management. Conceptually, supportive care aims to optimize symptom control, activate adaptive coping, and enhance understanding and participation in decision-making, thereby mitigating functional decline and psychological morbidity among patients and their caregivers.^48,49 Multimodal supportive care models were generally well received and showed potential benefits for addressing unmet needs; however, statistically significant improvements in quality of life were not consistently demonstrated.^34,37,39 Psycho-educational interventions, delivered through health education sessions, regular home visits, and printed materials, improved caregivers’ readiness and confidence, with short, structured interventions showing significant gains in preparedness for both short- and long-term caregiving.^{8,32,40,44,50,51} Booklets and other written resources were highly accepted when they used clear language, practical guidance, and contextually relevant information for home-based care, although some remained focused primarily on physical aspects of care.^21,50

Complementary interventions such as resonant breathing and pain-management education demonstrated benefits in caregiver-related outcomes, including improved autonomic regulation, caregiving confidence, and symptom-management competence.^42,52,53

Digital and technology-enabled interventions provided further benefits but also introduced notable barriers. Web-based and telephone-delivered programs, including video-conferenced care planning meetings and broader telehealth and mobile health tools, expanded access to education, communication, and psychological support for caregiver.^{22,31,32,35,42,54} Evidence regarding digital interventions was mixed. Some studies reported improvements in communication, preparedness, and access to support, whereas others found no significant effects on caregiver outcomes.⁵⁴ However, several implementation challenges were identified: limited non-verbal cues, rapid discussion pace, and technical problems reduced caregiver understanding, trust, and satisfaction, and sometimes prolonged or disrupted meetings.^22,31,32,35 In addition, some digital and educational interventions were narrowly targeted, such as booklets distributed only to families already receiving district nursing services, potentially overlooking broader psychosocial needs and limiting generalizability.²¹ These barriers intersect with structural constraints in low- and middle-income settings, including limited service coverage, workforce shortages, and disparities in digital literacy and infrastructure, which together affect the feasibility and equity of technology-based caregiver support.^55,56

Methodological and contextual barriers further influence the balance between benefit and burden of these interventions. Many studies were feasibility or pilot trials with small samples, heterogeneous designs, and short follow-up periods, constraining the strength of evidence and complicating cross-study comparisons.^{21,22,31,34,36,44,45} Some complex family-focused interventions, such as FamCope, yielded no significant improvements and even showed a tendency toward worse health outcomes among relatives over time, possibly reflecting the challenges of delivering intensive programs to families already under substantial strain.^33,57 Evidence from psychosocial oncology suggests that longer-duration interventions (eg, >12 weeks) are more effective in improving health-related quality of life, while even relatively brief psycho-educational programs can produce small but significant gains in caregiver readiness when carefully timed and tailored.^8,32,45 Moving forward, models such as Early Palliative Home Care Embedded in Cancer Treatment (EPHECT) offer a robust template for integrating home-based palliative care into oncology pathways through regular visits, structured communication guides, and coordinated collaboration between family caregivers, primary care, and specialist teams.^22,43,55 For contexts such as Indonesia, adapting these models will require culturally congruent, community-based strategies that leverage local human resources and participatory approaches that involve caregivers in co-designing and evaluating interventions to enhance relevance, acceptability, and sustainability.^55,56

Strength, Limitation, and Future Study

This review offers methodological rigor (PRISMA-ScR), broad database coverage, and structured charting that map caregivers’ multidimensional needs alongside a wide range of intervention modalities (psychoeducation, mindfulness, communication tools, and digitally delivered programs), yielding a decision-useful synthesis across physical, psychosocial-spiritual, quality-of-life, and feasibility outcomes. Nonetheless, heterogeneity in populations, settings, timing, and outcome measures often short-term and variably standardized, limits comparability and precludes meta-analysis, while mixed study designs without formal risk-of-bias synthesis (appropriate to a scoping approach), under-reporting of engagement/fidelity/dose/costs, and under-representation of LMIC contexts constrain certainty and generalizability. Future research should establish a core outcome set with common assessment time points (post-intervention, 3–6–12 months); use mechanism-driven designs that test mediators (knowledge, self-efficacy, communication quality) and moderators (relationship, stage, culture) through dyadic/triadic models; and advance pragmatic or hybrid effectiveness-implementation trials (with fidelity, engagement analytics, and cost-effectiveness). Priority areas include equity-focused adaptations and stratified analyses, longer follow-up spanning into bereavement, and evaluation of system-level effects (eg, service use, place of death). Blended delivery models (digital plus brief coaching) and integration with primary/community care warrant testing to define minimum effective dose and scalable pathways.

Conclusion

This scoping review demonstrates that home-based palliative care interventions for family caregivers of cancer patients provide benefits across four key outcome clusters: physical, psychosocial-spiritual, quality of life (QoL), and feasibility. Psychosocial-spiritual outcomes included improvements in emotional support, self-efficacy, coping, and psychological well-being, although findings regarding anxiety, depression, and caregiver burden were inconsistent. Evidence of improvements in QoL was reported in some studies, particularly those involving psychoeducational and self-care interventions, although overall findings remained mixed. In addition, many programs were found to be feasible and acceptable for implementation in home-based settings, although barriers related to recruitment, engagement, and contextual factors were frequently reported. Despite these promising findings, intervention effects were heterogeneous and influenced by caregiver characteristics, delivery methods, and healthcare contexts. Future home-based palliative care programs should adopt holistic, flexible, and culturally responsive approaches that address all four outcome domains and be evaluated through methodologically rigorous studies to strengthen the evidence base for family-centered caregiver support.

Funding Statement

The publication charge was supported by Universitas Padjadjaran (UNPAD) through the Indonesian Endowment Fund for Education (LPDP) under the Ministry of Higher Education, Science and Technology, as part of the EQUITY Program (Contract Nos. 4303/B3/DT.03.08/2025 and 3927/UN6.RKT/HK.07.00/2025).

Author Contributions

All authors have made significant contributions to the work reported, whether through conception, study design, execution, data collection, analysis, or interpretation. They participated in drafting, revising, or critically reviewing the article, gave final approval of the version to be published, agreed on the journal to which the article has been submitted, and are committed to being accountable for all aspects of the work.

Disclosure

The author(s) report no conflicts of interest in this work.