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A Randomized Clinical Trial on Family Hospice Caregivers (Guest Post by George Demiris, PhD)

July 3, 2012 | Author

Problem Solving Therapy (PST) has been found effective when delivered to informal caregivers of patients with various conditions. In hospice however its translation to practice is impeded by the increased resources needed for its delivery.

We designed a randomized non-inferiority trial with two groups, Group 1 in which caregivers received PST face to face, and Group 2 via videophone. Family hospice caregivers were recruited from two urban hospice agencies and received the PST intervention (in 3 visits for Group 1 or 3 video-calls in Group 2) in an approximate period of 20 days after hospice admission. Standard caregiver demographic data were collected. We also measured caregiver anxiety, quality of life and problem solving skills at baseline and at completion of the study. 126 caregivers were recruited in the study. PST delivered via video was not inferior to face to face delivery.

The observed changes in scores were similar for each group. Caregiver quality of life improved and state anxiety decreased under both conditions. Audiovisual feedback captured by technology may be sufficient, providing a solution to the geographic barriers that often inhibit the delivery of these types of interventions to older adults in hospice. This study demonstrated that the use of telehealth tools for the delivery of a cognitive behavioral intervention can be as effective as the face to face delivery.

Conclusions: The delivery of PST via videophone was not inferior to face-to-face. Audiovisual feedback captured by technology may be sufficient, providing a solution to the geographic barriers that often inhibit the delivery of these types of interventions to older adults in hospice.

 George Demiris, PhD

University of Washington.

Reference:

Demiris G, Parker Oliver D, Wittenberg-Lyles E, et al: A Noninferiority Trial of a Problem-Solving Intervention for Hospice Caregivers: In Person versus Videophone. J Palliat Med. 2012 Jun;15(6):653-60. Epub 2012 Apr 26.

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Posted in Art of healing, Caregiver, Communication, Team
  • VJ Periyakoil, MD

    Thanks Dr. Demeris. Your RCT is an important effort on at least on two counts: 
    a. It helps to build the critically needed body of empirical evidence for the field of palliative care.
    b. It uses easily available and scalable technology to provide much needed care for a vulnerable population (caregivers of seriously ill patients).

    Points for consideration:
    a. You mention that the caregiver intervention was done 20 days after the pt’s hospice admission. Given the late hospice referrals, would it be reasonable to do the intervention earlier in the trajectory?
    b. Are you following the caregivers after the patient’s death? I would be curious if there are any group differences in your two cohorts over time i.e. will there be effects that manifest later in terms of caregiver satisfaction with care, usage of health care resources.
    Thanks again,
    VJ Periyakoil

  • George Demiris

    Thank you for your comments and questions.
    The entire intervention was delivered within 20 days (it required 3 visits/ video-calls, so we actually started with the intervention as close to admission as possible and ended all elements in an average of 20 days).
    We are now continuing this work in a new randomized clinical trial where we actually follow caregivers after the patient’s death to also assess the potential long lasting effects of the problem solving therapy and its potential impact on the bereavement process. We started last year this new four year clinical trial which includes an attention control group and two intervention groups (face to face and video).

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