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A Problem‐Solving Intervention for Hospice Family Caregivers: A Randomized Clinical Trial
Author(s) -
Demiris George,
Oliver Debra Parker,
Washington Karla,
Pike Kenneth
Publication year - 2019
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15894
Subject(s) - medicine , randomized controlled trial , anxiety , psychological intervention , quality of life (healthcare) , family caregivers , intervention (counseling) , caregiver burden , confidence interval , nursing , gerontology , physical therapy , family medicine , psychiatry , dementia , surgery , disease , pathology
OBJECTIVES Family caregivers of hospice patients have multiple needs as they try to cope during a stressful time. Translatable interventions effective in improving caregiver outcomes are greatly needed. Our objective was to assess the impact of a problem‐solving intervention (called Problem‐Solving Intervention to Support Caregivers in End‐of‐Life Care Settings [PISCES]) to support hospice caregivers on caregiver quality of life and anxiety, and compare its effectiveness delivered face to face and via videoconferencing. DESIGN In this 4‐year randomized clinical trial, caregivers were randomly assigned to a group receiving standard care with added “friendly calls” (attention control [AC] group), a group receiving standard care and PISCES delivered face to face (F2F), or a group receiving standard care and PISCES delivered via videoconferencing (VC). SETTING Home hospice. PARTICIPANTS A total of 514 caregivers participated (172 in AC, 171 in F2F, and 171 in VC). Caregivers were predominantly female (75%); mean age was 60.3 years. INTERVENTION PISCES includes a structured curriculum delivered in three sessions and motivates caregivers to adopt a positive attitude, define problems by obtaining facts, set goals, and generate and evaluate solutions. MEASUREMENTS Quality of life was measured by the Caregiver Quality of Life Index‐Revised; anxiety was measured by the Generalized Anxiety Disorder 7‐Item. Other measures included the Caregiver Reaction Assessment scale, demographic data, and an exit interview. RESULTS Compared with AC, caregivers in the F2F condition had postintervention reduced anxiety (−1.31 [95% confidence interval [CI] = −2.11 to .50]; p = .004) and improved social (.57 [95% CI = .19‐.95]; p = .01), financial (.57 [95% CI = .21‐.93]; p = .004), and physical quality of life (.53 [95% CI = .19‐.87]; p = .01). There were no differences in caregivers in the VC condition compared with the AC condition. CONCLUSION The PISCES intervention improves caregiver outcomes and is effective when delivered in person. How to integrate technology to reduce the intervention delivery cost warrants further investigation.