Caregiving constitutes a fundamental element in the provision of palliative care, serving as a critical bridge between the complex needs of patients and the healthcare system. Formal caregivers operate within structured clinical environments and are typically subject to institutional protocols and regulations. In contrast, informal caregivers, most commonly family members or close friends, provide sustained, unpaid care to individuals with serious or life-limiting conditions [1-3].

Both groups of caregivers are routinely exposed to considerable emotional strain, physical fatigue, and social isolation, all of which can have a profound impact on their overall well-being [4-7]. As the global population continues to age and the incidence of chronic diseases such as cancer, Alzheimer disease, and end-stage organ failure rises, the demand for caregiving, both formal and informal, is expected to increase significantly [1].

While palliative care aims not only to relieve patient suffering but also to enhance the quality of life for caregivers, the needs of these individuals often remain unaddressed [5,6]. The burdens associated with caregiving, particularly in end-of-life contexts, may result in caregiver burnout, a syndrome marked by emotional exhaustion, depersonalisation, and a diminished sense of professional or personal efficacy [1].

According to Shih et al. (2023), informal caregiver burden is characterised by physical and emotional exhaustion, psychological distress, family dependency, stress, and depersonalisation, among other factors, which can at times result in a decline in the quality of care provided to the dependent relative [2]. In contrast, as noted by Oware et al. (2024), formal caregiver burden is more closely associated with staff shortages, inadequate resources, excessive working hours, lack of recognition for work performed, and frequent exposure to patient death [3]. These circumstances underscore the necessity for targeted interventions that address the distinct characteristics and needs of each caregiver group [8,9].

This review was motivated by the growing recognition of caregiver burnout and the lack of cohesive strategies to support both formal and informal caregivers. Through a comprehensive synthesis of existing literature, we aim to identify nursing interventions that mitigate the challenges faced by caregivers in palliative contexts.

This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology, [10] and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was also followed [11]. The search was performed in October 2024 using the following databases: CINAHL, PubMed, and Cochrane Library. All types of studies were considered and included. The search was limited to the English and Spanish languages, from 2014 to 2024. No geographical or cultural limitations were imposed, and the reference lists of the full-text articles were screened for additional inclusion. The MeSH terms identified can be appreciated in Table 1 Participants, Concept, and Context (PCC) framework.

Table 1: PCC Framework.

The identified references were compiled, and duplicates were removed. Findings were preferred by a three-step process: title, abstract, and revision of the full text, as proposed by PRISMA-ScR guidelines [11]. The results of the search and the study inclusion process yielded sixteen relevant articles. The selection process can be appraised as follows in the PRISMA flow diagram Figure 1.

Figure 1: PRISMA Flow Diagram.

The literature found was assessed. After data extraction, all data were conferred by authors, and any disagreements or transcription errors were avoided. The study characteristics were summarized and presented in Table 2.

Table 2: Study Characteristics.

A relevant number of articles (n=16) were included in the final analysis. The studies were published between 2015 and 2024, exceptionally one article published in 2007 was included. The studies were conducted in ten different countries; and five studies were conducted on the United States.

The population comprises both formal and informal caregivers of patients receiving palliative care. A variety of nursing instruments have been identified to assess caregivers, including questionnaires, surveys, structured forms, and interviews. The assessment tools were frequently cited by different authors and can be appreciated in Table 3.

Table 3: Assessment Tools.

Among the various factors contributing to caregiver burden, psychological components are consistently reported as the most significant for both formal and informal caregivers. Traits such as extroverted personality, psychological instability, low self-esteem, anxiety, chronic stress, emotional exhaustion, depersonalisation, and both physical and emotional strain are frequently identified as key contributors [2,12]. Additionally, limited knowledge or training regarding caregiving responsibilities further exacerbates the burden.

As the illness progresses, the demand for healthcare services and their associated costs tends to increase, adding financial pressure and intensifying the caregivers’ responsibilities [12,13]. Furthermore, a negative attitude or excessive emotional involvement has also been linked to higher levels of caregiver strain [14]. The authors also reported that the absence of effective coping strategies significantly worsens the situation, particularly in challenging contexts such as during a pandemic or when caring for patients with advanced dementia [1,12,15].

The evidence consistently highlights the multidimensional challenges encountered by both formal and informal caregivers within palliative care settings. Informal caregivers frequently assume their roles with little to no training and insufficient preparation, which often precipitates rapid emotional and physical decline. In contrast, although formal caregivers are professionally trained, they are frequently constrained by systemic limitations that impede their ability to deliver compassionate and sustained care.

Several authors have emphasised that informal caregivers are especially vulnerable to resource deficiencies, particularly financial limitations, and to the intense dependency of the patients under their care [15-17]. These factors substantially exacerbate the degree of caregiver burden.

Moreover, there is a strong association between caregiver well-being and the quality of patient care [1,13,14,16,18]. When caregivers are overburdened, they are more likely to experience emotional detachment and burnout, which can compromise the safety, empathy, and effectiveness of care delivery [14,16,18]. As such, providing robust and sustained support to caregivers must be considered a fundamental component of all palliative care programmes.

The gendered nature of caregiving also emerges as a critical concern raised by multiple authors [1,12,16,19]. The disproportionate burden placed upon women reflects entrenched societal norms and expectations. This imbalance necessitates targeted public policies, including financial subsidies, access to respite care, and formal recognition of unpaid caregiving work within legal and institutional frameworks [12, 16].

Nurses occupy a central role in bridging the gap between patients' needs and caregivers' capacities. Through the implementation of holistic, family-centred care models, nursing professionals are well-positioned to initiate interventions that enhance caregiver well-being while simultaneously reinforcing the resilience and coherence of the broader care network [3,12-14,20].

Nursing interventions applicable to both formal and informal caregivers include a range of evidence-based strategies, such as the enhancement of coping mechanisms, the development of effective communication skills, active listening, bereavement support, the creation of social support networks, mindfulness practices, and expressive or therapeutic writing and reading [3,12-14,20,21]. Furthermore, early identification of caregiver burden, paired with timely therapeutic management, coordinated interventions, and inclusive decision-making processes involving both patients and families, has been shown to reduce psychological and emotional strain [17].

For formal caregivers, access to structured training programmes and the cultivation of peer and professional support systems are key strategies in mitigating burnout and fostering professional satisfaction [14]. Conversely, for informal caregivers, ensuring equitable access to care services and offering publicly funded or
low-cost interventions are essential measures to alleviate the burden and promote sustained engagement in caregiving responsibilities [15].

The present review reaffirms the critical role played by both formal and informal caregivers in the delivery of palliative care, while highlighting the substantial burden they face, physically, psychologically, and socially. Informal caregivers with limited resources and training, are particularly susceptible to emotional exhaustion and long-term health consequences. Evidence suggests that psycho educational interventions, digital health tools, and structured emotional support can modify this burden, enhancing caregivers' capacity to cope with prolonged caregiving demands, and ultimately improving the quality of care provided to patients.

Similarly, formal caregivers experience occupational stressors including understaffing, long shifts, and emotional fatigue, all of which are exacerbated by systemic limitations. To address these issues effectively, institutional reforms, continuous development, and formal recognition of emotional labour are essential.

Nurses hold a strategic and compassionate leadership position, acting as key facilitators of training and support for caregivers. Adopting integrated, patient and family-centred models of care, nurses can implement targeted interventions that address caregiver needs while reinforcing care continuity. Furthermore, investing in caregiver well-being should be regarded not only as an ethical obligation but as a strategic healthcare priority, essential to ensuring high-quality and sustainable palliative care services. A systemic commitment to caregiver support, grounded in evidence-based nursing practice and policy reform, is vital to promoting dignity, resilience, and compassion within caregivers in palliative care systems.

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