Results from the family and coping oriented palliative homecare intervention study (FamCope)—A randomized controlled trial

Abstract

We tested if a family-and-coping-oriented basic palliative homecare intervention (six visits within 15 weeks) could improve quality-of-life and reduce anxiety and depression of advanced cancer patients and their closest relative, and reduce acute hospital admissions of patients. Fifty-seven families were randomized, but patient enrollment was terminated before reaching target sample due to a low recruitment rate. We found no evidence of effect of the FamCope-intervention, but further investigation of effective methods to support how families cope with advanced cancer at home is needed as levels of distress is as high in relatives as it is in patients. However, duration of interventions to support family-coping may need a considerable time-span to show effect on quality-of-life. We recommend that recruitment is undertaken in close collaboration with the hospital clinics, and that complexity of problems is used as inclusion criterion to decide when a family-coping intervention is needed based on the level of problems and distress in the family.

Caring for people who take care: What is already done?

“…As for depression, five studies reported positive outcomes for this variable (Kissane et al, 2006; Fegg et al, 2013; Badr et al, 2015; Leow et al, 2015; von Heymann-Horan et al, 2018), suggesting that their interventions may have the potential to decrease its levels. In turn, three studies verified the opposite: there was not a significant reduction in levels of depression (Walsh et al, 2007; Ammari et al, 2018; Washington et al, 2018). Furthermore, anxiety declined significantly in four studies after the application of the intervention program (Fegg et al, 2013; Badr et al, 2015; von Heymann-Horan et al, 2018; Washington et al, 2018), but negative results were reported in the studies of Walsh et al (2007) and of Ammari et al (2018).…”

“…In turn, three studies verified the opposite: there was not a significant reduction in levels of depression (Walsh et al, 2007; Ammari et al, 2018; Washington et al, 2018). Furthermore, anxiety declined significantly in four studies after the application of the intervention program (Fegg et al, 2013; Badr et al, 2015; von Heymann-Horan et al, 2018; Washington et al, 2018), but negative results were reported in the studies of Walsh et al (2007) and of Ammari et al (2018). In fact, the last study verified that there was a tendency for relatives in the intervention group to present poorer outcomes than controls over time.…”

“…Five studies included six sessions (Manne et al, 2004; Walsh et al, 2007; Fegg et al, 2013; Badr et al, 2015; Ammari et al, 2018). Ten studies reported manualized interventions (i.e., manuals were developed to include the guidelines) or interventions following structured guidebooks/checklists (e.g., Manne et al, 2004; Walsh et al, 2007; Mowll et al, 2015; Schenker et al, 2018).…”

“…No significant results were shown in the study of Hudson et al (2005), which simply pointed to an overall decrease in anxiety in both groups (control and intervention groups). With regard to quality of life, there were five studies showing improvements in this domain after the interventions (Northouse et al, 2007; Fegg et al, 2013; Leow et al, 2015; Sun et al, 2015; Nguyen et al, 2018; Zimmermann et al, 2019), and three that did not (Walsh et al, 2007; Ammari et al, 2018; Washington et al, 2018).…”

“…Concerning the role of professionals during these interventions, within the four studies conducted by a multidisciplinary team that included nurses, two reported effectiveness of the programs, as quality of life (Sun et al, 2015; Nguyen et al, 2018), distress and burden improved after the intervention (Sun et al, 2015) along with preparedness (Nguyen et al, 2018), anxiety and depression, in comparison to the control group (von Heymann-Horan et al, 2018). Moreover, out of five interventions delivered only by nurses, only one reported that the effect of the intervention was less than expected (e.g., over time poorer outcomes, mainly in terms of emotional well-being, were verified; Ammari et al, 2018) and another one considered that future studies should investigate the small effect of the intervention on depression and quality of life, although feasibility was greatly supported (Washington et al, 2018). From the studies encompassing mental health professionals ( n = 5), all considered that the interventions led to the expected outcomes, being that one of them focused important experiences related to caregiving (e.g., posttraumatic growth, coping; Manne et al, 2004).…”