Meta-synthesis of qualitative research on comfort experiences of family caregivers in hospice care: a systematic review

Objective: Globally, only 14% of end-of-life patients receive hospice care. Family caregivers, who bear the long-term caregiving burden, have become "hidden patients," and their multidimensional comfort experiences encompassing physical, psychological, social, and economic aspects-urgently require attention. However, to date, no qualitative systematic review focusing on the comfort experiences of family caregivers in hospice care has been conducted either domestically or internationally. Therefore, this study employed a meta- synthesis approach to systematically synthesize caregivers' comfort experiences, aiming to propose strategies to alleviate core issues such as caregiving strain, psychological distress, financial burden, role conflict, and insufficient social support, thereby providing evidence-based guidance for developing hospice care interventions centered on enhancing caregiver comfort. Methods: A systematic search was conducted in PubMed, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases to identify qualitative studies on the comfort experiences of family caregivers in hospice care. The search period extended from database inception to December 2025. Methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. A meta-aggregation approach was employed to synthesize the findings. Results: A total of eight studies were included. From these, 24 findings were extracted, which were subsequently grouped into eight categories, and finally synthesized into three synthesized findings. Synthesized finding 1: Discomfort and changes experienced by caregivers of end-of-life patients. Synthesized finding 2: Facilitating factors that enhance the comfort of family caregivers during hospice care. Synthesized finding 3: Family caregivers' pursuit of multifaceted support. Conclusion: Family caregivers encounter various comfort-related challenges during hospice care. These findings highlight the urgent need to address caregivers' physical health and spiritual needs, provide professional knowledge and death education, and mobilize governments, healthcare institutions, and non-governmental organizations to offer economic support and institutional safeguards.