Interventions in Palliative Care Compatible With Cognitive Impairment: A Systematic Review

Abstract

Introduction: Patients with cognitive impairments, who may be unable to engage in traditional psychotherapies, may require support through non-cognitive interventions. This review synthesizes the existing literature to assess the evidence base for these interventions and to propose future directions for research. Methods: A comprehensive literature search was conducted across seven electronic databases on October 17, 2024. Eligible studies assessed psychological, emotional, social, or spiritual outcomes. Results: Seventy-three studies were included, conducted across 18 countries. Music therapy and art therapy had the strongest empirical support, with consistent effects on distress, emotional expression, social and spiritual connectedness, and finding meaning. Other approaches, including movement therapy, spiritual interventions, and pet therapy, showed promising but preliminary results. Aromatherapy and massage therapy yielded mixed findings, while energy-based methods lacked robust evidence. Most studies had a high risk of bias, primarily due to confounding. Few interventions were conducted with patients with cognitive impairments, despite their potential relevance. Conclusion: A variety of interventions compatible with cognitive impairment show promise in palliative care settings. However, existing empirical support is constrained by bias and a lack of research in cognitively-impaired populations.