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Randomized Controlled Trial
. 2019 Jul;67(7):1345-1352.
doi: 10.1111/jgs.15894. Epub 2019 Apr 4.

A Problem-Solving Intervention for Hospice Family Caregivers: A Randomized Clinical Trial

George Demiris  1 , Debra Parker Oliver  2 , Karla Washington  2 , Kenneth Pike  3
Affiliations
Randomized Controlled Trial

A Problem-Solving Intervention for Hospice Family Caregivers: A Randomized Clinical Trial

George Demiris et al. J Am Geriatr Soc. 2019 Jul.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT01444027.

Keywords: Problem-Solving Therapy; caregiving; hospice.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Timeline for data collection. CQLI-R, Caregiver Quality of Life Index-Revised; CRA, Caregiver Reaction Assessment; F2F, face to face; GAD-7, Generalized Anxiety Disorder 7-Item; PISCES, Problem-Solving Intervention to Support Caregivers in End-of-Life Care Settings; VC, videoconferencing.
Figure 2.
Figure 2.
Consolidated Standards of Reporting Trials (CONSORT) diagram.
See this image and copyright information in PMC

Comment in

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