Family-centered care for cancer patients and their families in developing countries: an integrative review

Abstract

Background

Cancer is a major and growing challenge in developing countries, where limited resources contribute to poor outcomes to patients and families. Family-centered care, which considers both cancer patients and their families as the central focus of care, has been shown to improve the health of cancer patients and their family caregivers. However, the existing evidence is primarily concentrated in high-income settings, and comprehensive data about family-centered cancer care in developing countries is lacking. Therefore, this review was conducted to synthesize the existing evidence on family-centered cancer care in low- and middle-income countries.

Methods

A comprehensive review was conducted using an integrative design. Relevant articles were searched in PubMed, ScienceDirect, Epistemonikos, the Cochrane Library, African Journals Online, and CINAHL. Data were extracted into a standardized data extraction form, and a narrative synthesis was employed to integrate and present the findings. Protocol registration number: CRD42025639842.

Results

Out of 336 identified records, 18 articles involving 2,373 participants were included in this review. Despite its limited implementation in low- and middle-income countries, family-centered care was associated with improvements in quality of life, psychosocial health, emotional wellbeing, lifestyle, social interaction, and functional status, and with a reduction in symptom burden among cancer patients. It also enhances quality of life and mental wellbeing, while reducing the caregiving burden among family caregivers.

Conclusion

Findings of this review underscore the beneficial effects of family-centered care in enhancing health outcomes for cancer patients and their family caregivers. However, its application remains significantly low in developing countries. Moreover, there is also a lack of a uniform definition and implementation strategy for family-centered care approach. Therefore, future research should focus on developing context-specific and culturally appropriate family-centered care models that can be effectively integrated into existing healthcare systems in developing countries.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12913-026-15069-x.

Background

Cancer is a major public health concern worldwide. The burden of cancer is increasing globally with approximately 20 million incident cases in 2022 and a projected increase to 35 million by 2050 [1]. Although the incidence of cancer is generally higher in high-income countries, it causes a disproportionately high mortality rate in low-and-middle-income countries (LMICs), where around 70% of global cancer-related deaths occur [1, 2]. This disparity is further reflected by the higher mortality-to-incidence ratio observed in LMICs [3]. Such imbalances highlight several epidemiological and systemic challenges in LMICs including limited access to screening and treatment, late-stage diagnosis and constrained health system capacity.

Cancer diagnosis often leads to psychological distress, depression and anxiety, not only for patients but also for their families, who often suffer from high levels of stress and burnout [4, 5]. Physically, cancer causes various problems, such as pain and treatment side effects among patients, and chronic fatigue and musculoskeletal strain among caregivers [6]. The high cost of cancer treatment and loss of productivity also cause economic hardships for patients and their families [7]. Given its multifaceted impacts, cancer treatment and control efforts require a comprehensive approach that considers the needs of both patients and their caregivers. Family-centered care (FCC) is one such approach that has been shown to enhance patient and family health outcomes [8].

Families play an important role in the management of cancer by providing emotional support, helping in the treatment process, assisting in activities of daily living, and facilitating home-based care [9]. Family caregivers are also crucial in coordinating medical appointments and ensuring treatment adherence, all of which contribute to better outcomes [10]. Involvement of families in cancer care not only improves patient outcomes but also promotes caregivers’ well-being, highlighting the necessity of integrating family-centered care models into oncology services [11].

Family-centered care is a model of care delivery that emphasizes collaborative and mutually beneficial interactions between patients, families, and healthcare workers in the planning, provision, and evaluation of healthcare services [12]. There is a lack of a universally agreed-upon definition for FCC, and its concepts vary depending on the context [13, 14]. Family-centered care considers both patients and their families as the focus of care, rather than focusing solely on patients [12, 15]. A review by Kokorelias and colleagues identified communication and collaboration, education and support, consideration of family context, and dedicated policies and procedures as key elements of FCC, which can serve as a springboard for analyzing this model of care [13]. Family-centered care has been shown to have a positive impact in various care contexts [8, 16]. Previously, it was primarily considered as an approach to be used when caring for children and their families; however, a growing body of evidence has highlighted that family-centered care can also be effectively applied when caring for adults [16, 17]. Researchers have advocated for the universal implementation of FCC, citing its positive impact on patient treatment outcomes, family health, and the efficacy and satisfaction of healthcare providers [13, 18]. Its improving effects have also been shown in cancer care [11]. Nevertheless, existing literature is predominantly concentrated in developed nations, highlighting the need for broader research to understand its application across different healthcare settings.

In high income countries, FCC is supported by multidisciplinary teamwork, established policies and structured models that promote caregiver participation and shared decision making [19, 20]. In contrast, although the implementation of FCC practices is underway in developing regions, their advancement is still in the nascent phases [21]. Many factors contribute to its limited implementation, including lack of standardized policy and organizational support [22], poor healthcare infrastructure and resources [14, 23], and absence of a clear and universal understanding of FCC tailored to the socio-cultural circumstances of these settings [24, 25]. Despite these hindrances, few studies have explored the family-centered approach in developing settings; yet, comprehensive evidence is still lacking. Moreover, its application in cancer care is particularly underexplored [21, 26]. Therefore, this review aims to synthesize the current evidence on FCC in cancer management in developing countries.

Methods and materials

Study design and protocol registration

A comprehensive review, incorporating quantitative and qualitative studies was conducted using an integrative design [27]. The protocol for this review was registered on the PROSPERO database with registration number: CRD42025639842. In addition, the reporting of this review was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines [28].

Information source and search strategy

A comprehensive electronic search was conducted in PubMed, ScienceDirect, Epistemonikos, the Cochrane Library, African Journals Online, and CINAHL to retrieve relevant records. The reference lists of pertinent articles were also scrutinized to identify additional studies. Database searches were conducted independently by two reviewers in March 2025, with no date restrictions applied. The following keywords were used, with refinements made to optimize the search for each database: Cancer OR “Cancer care” OR “Oncology care” OR “Cancer management” OR “Cancer treatment” AND “Family-centered care” OR “Family centered care” OR “Family-centred care” OR “Family centred care” OR “Family integrated care” OR “Family-centered nursing” OR “Family centered nursing” OR “Family-centered empowerment model” OR “Family centered empowerment model” AND “Families” OR “Family caregiver”.

Eligibility criteria

All primary studies that were conducted on the effect of FCC on the health of cancer patients and/or their families in low- and middle-income countries were included in this review. The World Bank’s country classification was consulted to verify the category of low- and middle-income countries at the time of the screening [29]. Studies that were conducted on patient-centered interventions, in developed countries, did not involve cancer patients and/or their families, or review articles, study protocols, editorial letters, conference abstracts, abstracts without full text, or preprints that have not undergone peer review were excluded from this review. This review included articles published in English, with no restrictions on the publication date.

Study selection and quality assessment

Articles identified through each database search were compiled into Endnote X7.2 software. All identified records were then imported into Covidence (www.covidence.org), to facilitate systematic review across all reviewers. Duplicate entries were automatically removed. All authors independently screened the titles and abstract of the remaining records with a double-screening rule within Covidence. For articles found to be relevant by title and abstract, a full-text review against the specified inclusion/exclusion criteria was conducted to identify potential articles to be included in this review. Similarly, the decision to include an article was made based on Covidence‘s double-screening rule, whereby two reviewers must recommend inclusion. In case of disagreement, the vote of the third reviewer was considered for resolution.

The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of included studies [30]. One reviewer initially evaluated quality of the included studies, which was then verified by two members of the review team. Any inconsistencies were resolved through discussion. Each study was evaluated against five methodological criteria relevant to its design. We reported the number of criteria satisfied but did not calculate an overall score, in accordance with MMAT guidelines (Supporting file) [30]. Furthermore, no studies were excluded because of a low-quality assessment score.

Data extraction and synthesis

Relevant data were extracted into a standardized data extraction form, which was developed based on the JBI guide for data extraction and synthesis [31]. Data were extracted by the primary author and reviewed and verified by the other two authors. Extracted data include author name, year of publication, country, country income category, aim, study design, sample size, study participants, setting (pediatrics or adult oncology), and main findings.

Quantitative pooling of evidence was not feasible due to substantial differences in the types of outcomes reported across the studies included. Therefore, a narrative synthesis was used to integrate and present findings. Content analysis was conducted to identify key themes within the included studies and to summarize the available evidence regarding family-centered oncology care in low- and middle-income countries.

Results

Identification of records

The combined literature search yielded 336 records, and 80 duplicate records were removed after import via Covidence. The first screening removed 199 articles that were not relevant based on their titles and abstracts. Finally, after reviewing the full text of 57 articles, 18 primary studies were included in this integrative review (Fig. 1).

Fig. 1.

PRISMA flow chart for articles screened and included

Overview of included studies

In this review, a total of 18 studies with 2,373 participants were considered. Of these participants, 862 were cancer patients, 1,506 were family caregivers, and five were healthcare professionals. The included studies were conducted in seven LMICs: six originated from Iran [32–37], five from China [38–42], three from Ethiopia [26, 43, 44], and one each from Indonesia [45], Thailand [46], Turkey [47], and Pakistan [48]. Methodologically, the studies employed various research designs: six utilized a quasi-experimental design [34, 36, 37, 45, 46, 48], five implemented randomized controlled trials [32, 33, 35, 40, 41], four adopted a cross-sectional design [26, 39, 44, 47], two employed qualitative methods [42, 43], and the remaining one used a cohort study design [38]. Fourteen of the studies were from upper-middle-income countries [32–42, 45–47], one was from a lower-middle-income country [48], and three were from one low-income country [26, 43, 44]. Furthermore, half of the included studies were conducted in pediatrics oncology, and the other half were in adult oncology settings (Table 1).

Table 1.

Summary of main findings of included studies

Study/ Country/ Level of country	Aim (Subject explored)	Study design	Sample characteristics	Intervention	Outcome measures	Main findings
Arief et al., 2019 [45]/ Indonesia/ UMIC	Effect of family-centered empowerment model on health status of children with leukemia	Quasi-experimental	30 mother-child dyads with leukemia	Family-centered empowerment model	Not reported	- Significant improvement in child health -Decreased bleeding frequency - Improved body weight -Improved ability of mothers to care for their children
Ay et al., 2024 [47]/ Turkey/ UMIC	The association between family-centered care, unmet care needs, and psychosocial problems in parents of children with cancer	Cross-sectional	136 parents of children with cancer undergoing treatment	Family-centered care, measured by family-centered care scale	Depression anxiety stress scale (DASS 21) Family-Centered Care Scale (FCCS) Family inventory of needs – pediatrics II (FINPED-II)	- Family-centered care is significantly correlated with mental health of parents. It reduces levels of anxiety, depression, and stress. - FCC is also positively correlated with the met needs of parents.
Cheng et al., 2020 [38]/ China/ UMIC	Effect of family integrated care on: 1. Effectiveness of intrathecal morphine pump management for refractory cancer-related pain 2. Performance score, and level of depression and anxiety	Cohort study	33 adult cancer patients	-Family integrated care. Training of families/caregivers on professional nursing care, which included psychological intervention, health education, medication care, and living care. -They also participated in decision-making and shared information with medical staff.	Numerical pain rating scale (NPRS) Karnofsky performance score (KPS) Self-rating anxiety scale (SAS) Self-rating depression scale (SDS)	-Family integrated care (FIC) significantly enhanced the effectiveness of intrathecal morphine pump therapy thereby reducing cancer-related pain. -Family-integrated care has significantly raised patients’ performance scores (Karnofsky performance scores). -Family-integrated care has also significantly reduced anxiety and depression among cancer patients. -No significant difference was observed in the survival rate of patients in the FIC and traditional groups.
Davarpanah et al., 2017 [32]/ Iran/ UMIC	Effect of family-based empowerment on quality of life of adults with leukemia	Randomized controlled trial	38 adult leukemia patient and caregiver dyads	Family-based empowerment model	Quality of life-cancer survivor questionnaire (QoL-CS)	-There was a statistically significant improvement in all aspects of quality of life of leukemia patients in the intervention group than those in the control group -There was also a significant change in quality of life before and after the intervention
Deribe et al., a 2024 [43]/ Ethiopia/ LIC	Effect and delivery of family-centered care in pediatrics cancer unit	Descriptive qualitative study using thematic analysis	13 parents of children with cancer and 5 healthcare providers	Family-centered care	-Not applicable	-Parent involvement in childcare has improved child-parent communication, decreased child stress, and enhanced child recovery and happiness. -It also helps to improve their quality of life and their family’s happiness and satisfaction. -Parents outlined that the education and guidance provided by healthcare providers helped them engage more effectively in their childcare. -But, there is a lack of adequate, engaging, and need-based counseling and information for parents about their children’s illnesses. The lack of separate education sessions and teaching aids also makes information delivery difficult, if not impossible. -Poor attention and support given to parents’ own health.
Deribe et al., b 2024 [44]/ Ethiopia/ LIC	The association between family-centered care and psychological distress among caregivers of children with cancer	Cross-sectional study	384 caregivers of children with cancer	Family-centered care. It was measured using the measure of processes of care.	Kessler psychological distress scale (K10)	-Family-centered care was significantly associated with caregiver psychological distress. Accordingly, caregivers who reported a unit increase in the level of family-centered care received were found to reduce psychological distress by 32%.
Deribe et al., c 2024 [26]/ Ethiopia/ LIC	Level of family-centered care and its determinants in a pediatric oncology unit	Cross-sectional study	389 parents of children with cancer	Family-centered care	Measure of processes of care (MPOC-20)	-The implementation of family-centered care is significantly low based on parents’ perceptions. -Information sharing about children’s illness and treatment process is the least implemented component of family-centered care.
Farahani et al., 2018 [33]/ Iran/ UMIC	Effect of the family-centered empowerment model on the lifestyle of children suffering from leukemia.	Randomized controlled trial	30 child with leukemia and parent dyads	Family-based empowerment model was implemented based on four stages: perceived threat, self-efficacy, self-esteem and process evaluation	Lifestyle questionnaire composed of five dimensions: nutrition, sleep, physical activity, physical health, and stress	-Family-centered empowerment model significantly improved the lifestyle (nutrition, sleep, physical activity, physical health, and stress) of children suffering from leukemia.
Hosseini et al., 2016 [34]/ Iran/ UMIC	Impact of family-centered empowerment model on quality of life and symptom scale of women with breast cancer	Quasi-experimental	70 women with breast cancer	- Family-centered empowerment model was implemented emphasizing the effectiveness of the family’s role across three dimensions: motivational, psychological, and functional.	EORTC QLQ-C30 EORTC QLQ-Br23	-Implementation of family-centered empowerment model significantly improved the quality of life of women with breast cancer. -It also significantly reduced symptom scores for women on chemotherapy.
Klankaew et al., 2023 [46]/ Thailand/ UMIC	Effect of family involvement program on anxiety and depression of patients with advanced hepatocellular carcinoma	Quasi-experimental	40 male advanced hepatocellular carcinoma patient and caregiver dyads	Nurse-led family involvement program was implemented. It focused on four aspects of family involvement: information sharing, care decisions, care provision, and psychological support.	Hospital Anxiety and Depression Scale (HADS).	-There was a significant reduction in anxiety and depression levels in the intervention group than those in the control group. -There was also a significant reduction in anxiety and depression among patients within the intervention group after the intervention.
Mahir et al., 2024 [48]/ Pakistan/ LMIC	Effect of family-centered education (care) for mothers of children with leukemia on the children’s quality of life.	Quasi-experimental	44 child with leukemia and mother dyads	Family-centered empowerment intervention was implemented, focusing on educating mothers about their children’s conditions.	Mothers’ knowledge of treatment Children’s quality of life No details of tools reported	-Family-centered education for mothers significantly improved their understanding of their children’s conditions, thereby improving the quality of life of children with leukemia.
Mahmmodi et al., 2016 [35]/ Iran/ UMIC	Effect of family-based education on levels of depression in patients with gastric cancer	Randomized controlled trial	78 adult gastric cancer patients	Family-based education program was implemented over five sessions for one week.	Beck’s depression inventory (BDI)	-Family-based disease-related education significantly reduced the level of depression among gastric cancer patients.
Shoghi et al., 2019 [36]/ Iran/ UMIC	Effect of family-centered empowerment model on care burden of parents of children with cancer	Quasi-experimental	78 child with cancer and parent dyads	Family-centered empowerment model was implemented aiming to enhance caregiver competence in taking care of children with cancer.	Zarit Burden Interview	-Family-centered empowerment model significantly reduced the care burden of parents.
Sona et al., 2016 [37]/ Iran/ UMIC	Impact of family-centered empowerment model on quality of life of women with breast cancer	Quasi-experimental	70 women with breast cancer	Family-centered empowerment model was implemented to enhance family health by emphasizing the effectiveness of the family’s role across three dimensions: motivational, psychological, and functional design.	EORTC QLQ-C30 EORTC QLQ-Br23	-Family-centered empowerment model significantly improved the quality of life of women. -However, there was no statistically significant difference in terms of body image, sexual pleasure, and attitude toward the future between the two groups.
Yalin Zhang et al., 2023 [39]/ China/ UMIC	The association of family resilience (family communication and problem-solving, utilizing social and economic resources, maintaining a positive outlook, family connectedness, family spirituality, and the ability to make meaning of adversity) with caregiver burden	cross-sectional study design	213 adult caregivers of lung cancer patients	Family resilience and social support	Zarit Burden Interview (ZBI) Perceived Social Support Scale (PSSS)	-Family resilience has both direct and indirect roles in decreasing the caregiver burden of family caregivers of patients with lung cancer. -There is a significant negative association between social support and caregiver burden.
Yao Zhang et al., 2023 [40]/ China/ UMIC	Effect of family-centered positive psychological intervention on quality of life and psychological experiences of breast cancer patients and their caregivers.	Randomized controlled trial	98 adult woman with early-stage breast cancer and caregiver dyads	Family-centered positive psychological intervention was implemented for four weeks. The intervention consisted of four structured units: identify your positive emotions; enjoy your positive emotions; face your unhappiness; and with positive emotions, we move forward together.	Connor-Davidson Resilience Scale (CD-RISC) Herth Hope Index (HHI) Perceived Benefits of Diagnosis and Treatment of Breast Cancer (PB-DT-BC) Positive Aspects of Caregiving (PAC) Functional Assessment of Cancer Therapy-Breast (FACT-B)	-Family-centered positive psychological intervention significantly improved quality of life, resilience, hope, and perceived benefits among breast cancer patients. -The intervention also significantly improved caregivers’ quality of life, resilience, hope, and positive aspects of caregiving.
Yu et al., 2014 [41]/ China/ UMIC	Effect of family-centered nursing care on social adaption capability of preschool children with cancer	Randomized controlled trial	240 preschool children (3–7 yrs) and their parents	Family-centered nursing care was implemented over 12 weeks, incorporating physical, psychological, and social interventions. Key components included self-management education, personalized plans with digital support, skill-building activities, and a final assessment.	Revised Infants-Junior Middle School Student’s Social Adaptation Capability Scale	-The family-centered nursing care model significantly improved the social adaptation capability of preschool children with cancer.
Yue et al., 2025 [42]/ China/ UMIC	Dyadic coping experiences of hepatocellular carcinoma patients and their spouses following postoperative recurrence	Descriptive qualitative research design using thematic analysis	13 recurrent hepatocellular carcinoma patient and spouse dyads	Dyadic care for cancer patients and their spouses.	-Not applicable, description.	- Spouses play a critical role as decision-makers and pillars of support, helping patients avoid bothering about the treatment process. - Spouses protected patients and other family members from emotional distress by concealment or selectively sharing details of unfavorable information. - Spouses reported taking on additional family responsibilities to ensure a stable home environment, sparing their partners from further burdens. This commitment allowed patients to feel supported, strengthening their bond and mutual resilience. -Some spouses also adjusted dietary practices, reducing processed and unhealthy foods in favor of home-cooked meals. -Spouses promote psycho-social health by promoting calming activities like Tai Chi exercises. -Spouses remained proactive and motivated patients to adhere to and continue treatment when they became reluctant.

Key; LIC: Low Income Country, LMIC: Lower-Middle Income Country, UMIC: Upper-Middle Income Country

Scope and implementation status of FCC

Despite our comprehensive search, only 18 eligible studies were identified on FCC in LMICs, with the majority originating from upper-middle-income Asian countries. Only three studies were conducted in Africa, and none of them were clinical trials. In addition to this evidence imbalance, there is considerable variation in the implementation status of different components of FCC. For instance, a cross-sectional analysis conducted in Ethiopia found a significantly low level of FCC in pediatric oncology units. It underscores that information sharing about children’s illness and treatment process is the least implemented component [26]. This finding is also supported by other included studies that reported a lack of structured caregiver education, insufficient communication, and limited psycho-social support [42, 43].

Moreover, FCC was implemented using a variety of strategies, reflecting the lack of a consistent and standardized definition. Some studies implemented a structured family-centered empowerment model, some applied an integrated care approach, and others administered family-based education and psychological intervention programs (Table 2).

Table 2.

Family-centered care approaches reported across included trials

Family-centered care approach	Description	Studies
Family-centered empowerment model	Involves a structured yet flexible program with four stages: recognizing the perceived threat of the disease, enhancing self-efficacy to support effective disease management, strengthening self-esteem to promote independence and responsibility in care, and implementing evaluation methods to assess the effectiveness of the program.	Arief et al. [45], Davarpanah et al. [32], Farahani et al. [33], Hosseini et al. [34], Shoghi et al. [36], Sona et al. [37],
Family-integrated care	Family caregivers received training in nursing care, including health education, psychological support, daily living assistance, and medication care (e.g., proper dosing). They were also involved in shared decision-making and communication with healthcare providers.	Cheng et al. [38],
Nurse-led family-involvement program	The program emphasized involving families in four key aspects: information sharing (education about the disease and its management), shared decision-making (facilitating family-provider discussions), care provision (hands-on assistance with daily needs like providing bed bath), and psychosocial support (e.g., active listening, emotional validation).	Klankaew et al. [46],
Family-based education program	This approach provided family-based education about the disease, treatment process, complications, and strategies to overcome complications.	Mahir et al. [48], Mahmmodi et al. [35],
Family-centered positive psychological intervention	The program consists of four structured modules: identify your positive emotions (optimism training); enjoy your positive emotions (savoring techniques); face your unhappiness (coping with negative emotions); and with positive emotions, we move forward together (gratitude and strength building).	Yao Zhang et al. [40],
Family-centered nursing care	The program implemented physical, psychological, and social interventions. Key components included: self-management education, personalized education plan tailored to each participant’s needs, structured skill-building activities, and comprehensive evaluation.	Yu et al. [41],

Effect of family-centered care on cancer patients

Findings from the included studies consistently report a positive effect of FCC on the health outcomes of cancer patients. Five studies have documented that FCC significantly improves the quality of life of cancer patients [32, 34, 37, 40, 48]. Two quasi-experimental studies conducted in Iran found that family-centered empowerment model significantly improves the quality of life of women with breast cancer [34, 37]. Another randomized controlled trial from the same country also reported a significant improvement in all aspects of quality of life, including the physical, psychological, social, and spiritual aspects, among leukemia patients following the implementation of the family-based empowerment model [32]. A quasi-experimental study by Mahir and colleagues found that family-based education for mothers of children with leukemia resulted in a significant improvement in mothers’ knowledge, thereby improving their children’s quality of life [48]. Similarly, another randomized controlled trial from China reported that family-centered positive psychological intervention significantly improves the quality of life and psychological experiences of breast cancer patients [40].

Family-centered care has been shown to enhance the psychosocial health and emotional wellbeing of cancer patients. A quasi-experimental study from Thailand found that nurse-led family involvement programs significantly reduce anxiety and depression among men with hepatocellular carcinoma [46]. Similarly, a cohort analysis conducted in China reported a significant reduction in cancer patients’ levels of anxiety and depression following family-integrated care [38]. A randomized controlled trial by Mahmmodi and colleagues also found that family-based education reduces depression among cancer patients [35]. Qualitative studies have similarly documented this finding. A qualitative exploration from China reported that dyadic care involving spouses helps to alleviate cancer patients’ concerns about the treatment process and mitigates emotional distress [42]. Spouses also support psycho-social well-being by encouraging calming activities like Tai Chi exercise [42]. Another qualitative study conducted in Ethiopia reinforces this finding, indicating that parental involvement in care reduces children’s stress and enhances their recovery and emotional health [43].

Family-integrated care fosters improved lifestyle and social interaction in cancer patients. A randomized clinical trial reported that family-centered empowerment approach significantly improves the lifestyle of children with leukemia, including aspects such as nutrition, sleep, and physical activity [33]. A similar finding is documented in a qualitative study [42]. Another randomized controlled trial indicated that family-centered nursing care significantly improves the social adaptation capabilities of preschool children with cancer, highlighting its role in enhancing social interaction [41].

Studies have also reported the positive effects of FCC in enhancing the effectiveness of medical procedures and reducing symptom burden. Cheng and colleagues found that family-integrated care reduces cancer-related pain by enhancing the effectiveness of intrathecal morphine pump therapy [38]. They also reported increased patient performance scores after the intervention [38]. Another quasi-experimental study from Indonesia supports this finding, reporting reduced bleeding and improved body weight outcomes following the implementation of the family-centered empowerment model [45].

In contrast, some findings indicate that there is no statistically significant difference in health outcomes for cancer patients related to FCC. For instance, a cohort study reported no significant difference in the survival rate of cancer patients between the family-integrated care and traditional care groups [38]. This finding may be attributed to the study’s short follow-up period of only 12 months, which could have led to incomplete observation of events and failure to capture long-term effects [49]. Another quasi-experimental study assessing the impact of family-centered empowerment model found no statistically significant differences in body image, sexual pleasure, or attitudes among breast cancer patients between the experimental and control groups [37]. This might be due to the small sample size of the study, which could have limited the ability to detect the true effect of the intervention.

Effect of family-centered care on caregivers

According to the findings of included studies, FCC has also demonstrated a positive impact on the health of caregivers of cancer patients. A quasi-experimental study by Shoghi and colleagues found that family-centered empowerment model significantly reduces caregiving burden among parents of children with cancer [36]. This finding is supported by another cross-sectional study, which showed the importance of family-based care in reducing caregiver burden [39]. In addition to easing caregiver burden, FCC also enhances the caregiving competencies of families [45].

Participating in the care of families affected by cancer optimizes the mental health of caregivers. One cross-sectional study indicated that a unit increase in the level of family-centeredness of care was associated with a 32% reduction in caregivers’ psychological distress [44]. Another study conducted in Turkey reported that FCC significantly reduces the level of anxiety, depression, and stress among parents of children with cancer [47]. The same study also found that FCC enhances the met needs of families.

Included studies have also documented the beneficial effect of family-based care on caregivers’ quality of life. A randomized controlled trial conducted in China found that family-centered positive psychological intervention significantly improves caregivers’ quality of life, resilience, hope, and positive aspects of caregiving [40]. This finding is supported by another qualitative exploration, which reported improvements in parents’ quality of life and their family’s satisfaction when they participate in the care of children with cancer [43].

Discussion

Research from high-income countries have demonstrated the effectiveness of family-centered cancer care and its expansion into interventions beyond pediatric care settings [13, 21]. However, despite a few primary studies, comprehensive evidence is lacking in LMICs. Hence, this integrative review was conducted to synthesize the existing evidence on FCC in cancer management within developing countries. Accordingly, although FCC is effective in improving the health outcomes of both cancer patients and their caregivers, its implementation remains significantly limited in LMICs.

In this review, we found limited research documenting the application of FCC in cancer care and also variation in the implementation status of its different components in LMICs. This contrasts with findings reported in developed settings [50], and might be attributed to differences in the availability of resources, healthcare infrastructure, and policies that support this holistic approach [51]. For instance, high income countries generally have manageable patient-to-provider ratios, allowing sufficient time and resources to involve families in the care process. Dedicated FCC training programs and well-established regulatory frameworks might also help to institutionalize family involvement in care [52]. By contrast, implementation in middle income countries tends to be uneven and partially scaled, reflecting incomplete infrastructure and inconsistent policy support [23]. Low income countries, on the other hand, demonstrated very limited FCC implementation, which might be due to constrained facilities, lack of integrated multidisciplinary teams, and overburdened healthcare staff [19, 21]. Furthermore, the absence of a universally accepted and consistent definition for FCC contributes to inconsistent intervention strategies, as reflected by the diverse approaches reported across the included studies [24]. These findings imply that the operationalization of FCC is influenced by socioeconomic factors and its broader implementation should be preceded by the development of a context specific FCC model that aligns with local needs and resources.

Improvements in quality of life were consistently reported across cancer patients and their family caregivers, and were often linked to the educational and supportive components of FCC interventions which empowered patients and families to actively participate in care [37, 40, 48]. Across the included studies, FCC appeared to improve quality of life by enhancing patients’ and caregivers’ understanding of the disease and treatment processes, increasing their involvement in care and strengthening communication with healthcare providers [32, 34, 43, 48]. Other studies from developed settings have also reported this finding [53, 54]. A possible explanation for this result is the informational, emotional, and practical support embedded within the FCC process, which helps patients and families better navigate the illness trajectory and reduces uncertainty [15]. The presence and active participation of families in FCC may also enhance patient motivation and overall satisfaction.

Similarly, our review documented the positive effect of FCC in enhancing the mental wellbeing of both cancer patients and their caregivers. Across studies, improvements in mental-wellbeing were associated with a better understanding of the disease and treatment process and an increased sense of ownership and involvement in the care plan [35, 38, 47, 55]. In addition, open communication and emotional support within FCC help patients and families feel understood and supported, which in turn reduces anxiety, depression and emotional distress for both groups [40, 42, 56]. These findings highlight FCC as a critical component of comprehensive cancer care, especially in resource-constrained settings where structured emotional and informational support is lacking.

Consistent with existing evidence [57], our review found that FCC promotes healthy lifestyles and positive social interaction among cancer patients. These benefits were linked to active family involvement in supporting healthy behaviors and social engagement [41, 42]. One possible explanation is that family involvement fosters a more supportive environment for adhering to a healthy diet and sleep pattern [58]. Families also play an active role in initiating and promoting physical activity and social engagement to enhance the health of their loved ones [42, 58]. The present review also indicated that family-integrated care reduces the symptom burden and increases the performance score of cancer patients. Across studies, these improvements were commonly attributed to the role of family members in supporting treatment adherence, monitoring symptoms and facilitating symptom management [34, 42, 59, 60]. This finding is corroborated by previous studies [61, 62], and suggests that FCC not only improves health outcomes but also enhances patients’ functional status.

Furthermore, this analysis found that family-integrated care reduces the caregiving burden and enhances the competency of family caregivers. Similar findings have been documented in earlier studies [63, 64]. This could be attributed to the shared responsibility and collaborative provision of care in FCC [15]. The structured education sessions in FCC also empower caregivers with the necessary knowledge and skills for caregiving [13, 65].

An important limitation of the current evidence base is the substantial heterogeneity in outcome measurement and intervention design. Primary studies labeled as FCC encompassed diverse interventions including empowerment models, family-integrated care, nurse-led family-involvement and family-based education, which differ conceptually and operationally. This makes it difficult to determine which specific components are most effective for which outcomes. In addition, variability was observed in the measurement of outcomes. For example, quality of life was measured using different tools including QoL-CS, EORTC QLQ -C30/QLQ-Br23 and FACT-B. Psychological outcome were measured using DASS-21, HADS, SAS, SDS, BDI and K10 tools. This variability limited direct comparison across studies and precluded quantitative synthesis of findings, highlighting the need for standardization in both outcome measurement and intervention definitions in future research.

This review also has methodological limitations. Although major databases were searched, key sources such as PsycINFO, Web of Science or Embase were not included, which may have resulted in the omission of relevant psychosocial oncology studies. Restricting inclusion to studies published in English may introduce language bias and reduce the comprehensiveness of the review. In addition, exclusion of unpublished research and gray literature may result in the omission of important studies. Finally, this study is only an integrative review, and there is a lack of pooled data to support its findings.

Conclusion

This review indicates that FCC positively influences health outcomes for both cancer patients and their family caregivers. Among patients, FCC is associated with enhanced quality of life, improved mental health, enhanced social interaction, better performance status and reduced symptom burden. For caregivers, FCC reduces the caregiving burden and promotes better mental health and quality of life. Despite these, the implementation of FCC in cancer care settings within LMICs, particularly in Africa, remains notably limited. Therefore, future research should prioritize the development of context-specific and culturally appropriate FCC models that can be effectively integrated into existing healthcare systems within these regions.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

FCC

Family-centered care

LMICs

Low- and middle-income countries

Author contributions

Conceptualization: HG, IG and EC. Data curation: HG, IG and EC. Formal analysis: HG, IG and EC. Investigation: HG, IG and EC. Project administration: HG, IG and EC. Resources: HG, IG and EC. Writing original draft: HG. Writing – review & editing: HG, IG and EC. All authors have read and approved the final version of this manuscript.

Funding

The authors received no specific funding for this work.

Data availability

All relevant data are within the manuscript and its supporting files.

Declarations

Ethics approval and consent to participants

Not applicable because no primary data were collected.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.