Family Caregiver Depressive Symptom and Grief Outcomes From the ENABLE III Randomized Controlled Trial

Abstract

Context Little is known about whether early palliative care (EPC) support for family caregivers (CGs) impacts depressive symptoms and grief after care recipients die. Objectives To assess after-death CG depressive symptom and grief scores for early compared to delayed group CGs. Methods We conducted a randomized controlled trial (RCT) (10/2010-9/2013) of an EPC telehealth intervention for CGs (n=123) initiated at the time of care recipients' advanced cancer diagnosis (early group) or 12 weeks later (delayed group) in a rural comprehensive cancer center, affiliated clinics, and a Veterans Administration medical center. The ENABLE [Educate, Nurture, Advise, Before Life Ends] CG intervention consisted of three weekly sessions, monthly follow-up, and a bereavement call. CGs completed the Center for Epidemiological Study-Depression scale (CESD) and the Prigerson Inventory of Complicated Grief-Short Form (PG13) 8-12 weeks after care recipients' deaths. Crude and covariate-adjusted between-group differences were estimated and tested using general linear models. Results For care recipients who died (n=70), 44 CGs (early: n=19; delayed: n=25) completed after-death questionnaires. Mean depressive symptom scores (CESD) for the early group was 14.6 (standard deviation [SD]=10.7) and for the delayed group was 17.6 (SD=11.8). Mean complicated grief scores (PG13) for the early group was 22.7 (SD=4.9) and for the delayed group was 24.9 (SD=6.9). Adjusted between-group differences were not statistically significant (CESD: d=0.07, P=0.88; PG13: d=-0.21, P=0.51). Conclusion CGs' depressive symptom and complicated grief scores 8-12 weeks after care recipients' deaths were not statistically different based on the timing of EPC support. The impact of timing of CG EPC interventions on CGs bereavement outcomes requires further investigation.

Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review (Preprint)

“…Five studies reported significant differences in Quality of Life aspects: three of them showed significant effects in all dimensions of Quality of Life [52,65,67]; Two studies showed significant effects in spiritual and social well-being [59,65], while one study [60] showed significant outcomes in social well-being. Emotional distress or stress symptoms revealed significant differences between pre-and post-treatment in five of the considered studies [50,52,65,67,69], while both depressive symptoms [55,57,65] and perceived social support [62,65,66] improved in three different trials. Furthermore, included articles reported significant effects -albeit smaller -in other measured outcomes: after the completion of the interventions, family members also experienced less anxiety, less sense of disruptiveness, hopelessness and uncertainty, less burden, and negative appraisal of caregiving.…”

“…Dyads dealt with different types of cancer at different stages; among included studies, lung and gastrointestinal cancers were the most considered, followed by genitourinary and breast tumours, and haematological neoplasms (see Figure 2). Of the 24 studies, eight focused on advanced cancers [48,51,[54][55][56][57][58][59], two on early-stage tumours [60,61], while other trials included patients with all stages of the disease.…”

“…In twelve papers an intervention was developed an intervention for a unique type of cancer patients [49,[51][52][53][54]58,60,61,65,66,68,70], while the others implemented telemedicine tools for a multifaceted sample including patients with different cancer diagnoses [48,50,[55][56][57]59,[62][63][64]67,71].…”

“…Dionne-Odom [56,57] published two articles on advanced cancer patients and their caregivers under the ENABLE III Project; three studies [51,55,58] were conducted within the ambit of the CHESS program. Five studies [52,54,59,67,71] were under the FOCUS Program, while Badger et al conducted three RCT studies on breast [60,68] and prostate [65] cancer patients and their partners to examine the effectiveness of two different telephone interventions.…”

End-of-Life Care Matters: Palliative Cancer Care Results in Better Care and Lower Costs

“…The ENABLE III trial compared the timing of PC tele‐health caregiver counseling support when given early (≤60 days of advanced‐cancer diagnosis) versus delayed (≥12 weeks of diagnosis) and found that prior to death, caregivers in the early group had lower depressions scores 3 months after intervention . However, there was no differences between groups on depression or complicated‐grief scores at 8–12 weeks after death . To our knowledge, no study has compared the impact of counseling by PC versus the standard of care on bereaved family/caregiver outcomes following a cancer death…”