Abstract：
Self-direction is an approach that allows older adults and people with disabilities to determine the home- and community-based services they receive, including the ability to hire caregivers of their choice. Self-direction has been shown to improve outcomes for the service recipients. The promotion of choice and control in self-direction may also affect family caregivers. We conducted a systematic review examining the impact of self-direction on a broad range of caregiver outcomes.
We conducted a systematic review guided by PRISMA guidelines. Literature search was conducted in 8 databases. We appraised risk of bias using the Joanna Briggs Institute critical appraisal checklists and assessed certainty of evidence using the GRADE framework.
Sixteen studies meeting inclusion criteria were included. We found, with moderate certainty, that self-direction is associated with improved caregivers\' personal and social well-being. Caregivers also reported reduced unmet needs and increased access to care for the care recipients under self-direction. Self-direction did not appear to reduce caregiving hours. With less certainty, self-direction was also positively associated with increased respite care use, perception of choice, and intention to continue caregiving by caregivers.
Beyond delivering person-centered services that improve recipient outcomes, self-direction may also improve the outcomes of family caregivers.
We conducted a systematic review guided by PRISMA guidelines. Literature search was conducted in 8 databases. We appraised risk of bias using the Joanna Briggs Institute critical appraisal checklists and assessed certainty of evidence using the GRADE framework.
Sixteen studies meeting inclusion criteria were included. We found, with moderate certainty, that self-direction is associated with improved caregivers\' personal and social well-being. Caregivers also reported reduced unmet needs and increased access to care for the care recipients under self-direction. Self-direction did not appear to reduce caregiving hours. With less certainty, self-direction was also positively associated with increased respite care use, perception of choice, and intention to continue caregiving by caregivers.
Beyond delivering person-centered services that improve recipient outcomes, self-direction may also improve the outcomes of family caregivers.
摘要：
目标：自我指导是一种方法，它允许老年人和残疾人确定他们接受的家庭和社区服务，包括雇佣他们选择的护理人员的能力。自我指导已被证明可以改善服务接受者的结果。促进自我指导的选择和控制也可能影响家庭照顾者。我们进行了系统评价，研究了自我指导对广泛的照顾者结果的影响。
方法：我们在PRISMA指南的指导下进行了系统综述。在8个数据库中进行文献检索。我们使用JoannaBriggs研究所的关键评估清单评估了偏见的风险，并使用GRADE框架评估了证据的确定性。
结果：纳入了符合纳入标准的16项研究。我们发现,适度的确定性，自我指导与改善护理人员的个人和社会福祉有关。护理人员还报告说，未满足的需求减少了，在自我指导下，护理人员获得护理的机会增加了。自我指导似乎并没有减少护理时间。在不太确定的情况下，自我指导也与增加喘息护理的使用呈正相关，对选择的感知，并打算继续由护理人员照顾。
结论：除了提供以人为中心的服务以改善接受者的结果之外，自我指导也可以改善家庭照顾者的结果。
方法：我们在PRISMA指南的指导下进行了系统综述。在8个数据库中进行文献检索。我们使用JoannaBriggs研究所的关键评估清单评估了偏见的风险，并使用GRADE框架评估了证据的确定性。
结果：纳入了符合纳入标准的16项研究。我们发现,适度的确定性，自我指导与改善护理人员的个人和社会福祉有关。护理人员还报告说，未满足的需求减少了，在自我指导下，护理人员获得护理的机会增加了。自我指导似乎并没有减少护理时间。在不太确定的情况下，自我指导也与增加喘息护理的使用呈正相关，对选择的感知，并打算继续由护理人员照顾。
结论：除了提供以人为中心的服务以改善接受者的结果之外，自我指导也可以改善家庭照顾者的结果。
