Benefits of immediate versus delayed palliative care to informal family caregivers of persons with advanced cancer: Outcomes from the ENABLE III randomized clinical trial.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. LBA9513-LBA9513
Author(s):  
J Nicholas Dionne-Odom ◽  
Andres Azuero ◽  
Kathleen Lyons ◽  
Zhongze Li ◽  
Tor Tosteson ◽  
...  
2014 ◽  
Vol 32 (18_suppl) ◽  
pp. LBA9513-LBA9513 ◽  
Author(s):  
J Nicholas Dionne-Odom ◽  
Andres Azuero ◽  
Kathleen Lyons ◽  
Zhongze Li ◽  
Tor Tosteson ◽  
...  

LBA9513 Background: Family caregivers of individuals with advanced cancer experience significant burden and diminished QOL; few interventions have been found to reduce these outcomes. Methods: Randomized clinical trial conducted from 10/11/2010 to 9/5/2013 of immediate versus delayed (initiated 12 weeks after randomization) entry patients (n=207) and caregivers (n=122) into ENABLE (Educate, Nurture, Advise, Before Life Ends), a phone-based concurrent oncology palliative care intervention. QOL (Caregiver Quality of Life-Cancer, lower scores=better QOL), depression (Center for Epidemiological Study-Depression) and burden (Montgomery Borgatta Caregiver Burden Scale; subjective burden [SB], objective burden [OB]; demand burden [DB]) measures were collected at baseline, 6, 12, 18, and 24 weeks, and every 12 weeks until patient death or study completion. Results: Estimated treatment effects (immediate minus delayed) for caregivers from randomization to 12 weeks were (mean [SE]): -3.1 [2.3] for QOL (P=.17), -4.1 [1.3] for depression (P=.003), -1.0 [0.4] for SB (P=.02), 0.3 [0.6] for OB (P=.60), and -0.5 [0.6] for DB (P=.39). Estimated treatment effects (immediate minus delayed) from intervention initiation to 12 weeks were (mean [SE]): -6.4 [3.4] for QOL (P=.06), -7.4 [2] for depression (P<.001), -1.0 [0.6] for SB (P=.08), -0.6 [0.7] for OB (P=.44), and -0.5 [0.8] for DB (P=.50). Estimated treatment effects (immediate minus delayed) measured backwards from the time of patient’s death were (mean [SE]): of -4.9 [2.6] for QOL (P=.07), -3.8 [1.5] for depression (P=.02), -1.1 [0.4] for SB (P=.01), -0.6 [0.6] for OB (P=.26), and -0.7 [0.6] for DB (P=.22). Conclusions: Caregivers in the immediate group had lower depression, SB, and trends towards better QOL in comparisons up to 12 weeks, following initiation of the intervention in both groups, and in the terminal decline analysis. These results suggest that concurrent oncology palliative care should be initiated as early as possible to maximize benefit to caregivers. Clinical trial information: NCT01245621.


2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 16-16
Author(s):  
Diane E. Holland ◽  
Catherine E. Vanderboom ◽  
Joan M. Griffin ◽  
Ann Marie Dose ◽  
Ellen M. Wild ◽  
...  

16 Background: Family caregivers have been shown to have their own unique challenges when caring for someone with advanced cancer. These challenges may be more pronounced among rural caregivers. We present early lessons regarding caregiver needs from an intervention study that provides teaching, guidance, and counseling to rural family caregivers of individuals who received palliative care in the hospital and transitioned home. Methods: A randomized clinical trial is underway to test the efficacy of a care model that focuses on supporting rural family caregivers’ medical needs, self-care, and direct caregiving needs. We have developed a nurse-led, technology-enhanced intervention for family caregivers delivered over 8 weeks after hospital discharge of those receiving palliative care consults. The intervention includes video and phone visits between a palliative care nurse and caregiver. Caregiver needs and nurse strategies are documented using a standardized terminology in an electronic datafile. Results: Preliminary data from 21 family caregivers of individuals with advanced cancer who completed the intervention to date indicate caregivers personally had an average of 2.2 chronic conditions (up to 10) and were taking an average of 3.14 (up to 11) medications. In addition to challenges providing direct care, caregivers reported difficulty managing stress or depression (7/21; 33.3%); issues related to grief (6/21; 28.5%); inadequate sleep and rest (6/21; 28.5%), low or no income or uninsured medical expenses (5/21; 23.8%); and interpersonal challenges within families and with friends (5/21, 23.8%). Conclusions: Preliminary data from our study suggest that assessing the caregiver’s individual needs related to well being and self-care as well as direct caregiving is imperative to delivering caregiver support services that can improve the ability of family caregivers to provide care for their loved ones with advanced cancer. Clinical trial information: NCT03339271.


2012 ◽  
Vol 22 (3) ◽  
pp. 555-563 ◽  
Author(s):  
Laurel L. Northouse ◽  
Darlene W. Mood ◽  
Ann Schafenacker ◽  
Gregory Kalemkerian ◽  
Mark Zalupski ◽  
...  

BMC Medicine ◽  
2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Patrick D. Hoek ◽  
Henk J. Schers ◽  
Ewald M. Bronkhorst ◽  
Kris C. P. Vissers ◽  
Jeroen G. J. Hasselaar

2019 ◽  
Vol 8 (4) ◽  
pp. 381-389 ◽  
Author(s):  
Vittorio Franciosi ◽  
Giuseppe Maglietta ◽  
Claudia Degli Esposti ◽  
Giuseppe Caruso ◽  
Luigi Cavanna ◽  
...  

2006 ◽  
Author(s):  
Timothy R. Elliott ◽  
Patricia Rivera ◽  
Jack W. Berry ◽  
Kim Oswald ◽  
Joan Grant ◽  
...  

2019 ◽  
Vol 67 (7) ◽  
pp. 1345-1352 ◽  
Author(s):  
George Demiris ◽  
Debra Parker Oliver ◽  
Karla Washington ◽  
Kenneth Pike

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