Effects of the Values and Options in Cancer Care Communication Intervention on Personal Caregiver Experiences of Cancer Care and Bereavement Outcomes

Abstract

Background: Care teams are increasingly expected to attend to the needs of patient's personal caregivers (e.g., family members). Improving communication among oncologists, patients with advanced cancer, and their personal caregivers might enhance caregivers' experiences of end-of-life (EoL) cancer care and bereavement outcomes. Objective: To explore the effects of the Values and Options in Cancer Care intervention on caregivers' experiences of EoL care and bereavement outcomes. Design: We developed a brief behavioral intervention to improve communication among oncologists, patients with advanced cancer, and their personal caregivers. The intervention was designed to help patients/caregivers ask questions, express concerns, and help oncologists respond effectively. We randomly assigned oncologists (and their patients/caregivers) to the intervention or usual care. Setting/Subjects: Medical oncologists in NY and CA; patients/personal caregivers with advanced cancer. Measurements: Two months after the patient's death, caregivers completed three instruments assessing their experiences of EoL care. Seven months after the patient's death, caregivers completed the Prolonged Grief Disorder-13 (PG-13; primary prespecified outcome), the Purpose-in-Life scale, and scales assessing mental health function, depression, and anxiety. Results: The intervention did not significantly improve caregivers' scores on the PG-13 (p = 0.21), mental health function, depression, or anxiety, but it did improve purpose-in-life scores (p = 0.018). Cohen's d (95% confidence interval) for all three experiences of EoL care outcomes were promising, ranging from 0.22 (-0.19 to 0.63) to 0.39 (-0.07 to 0.86) although none was statistically significant. Conclusion: Preliminary findings show promise that scalable interventions in cancer care settings may improve caregiver experiences with cancer care and some bereavement outcomes.

Keywords: bereavement; cancer; caregiving; communication interventions; patient-physician communication; prolonged grief; purpose in life; satisfaction with care.

FIG. 1.

CONSORT diagrams depicting the flow of oncologists (n = 38) and patients (n = 265) were published elsewhere. Most caregivers were patients' spouses or in a committed relationship; the remainder were patients' children and friends, neighbors, or other relatives. Patients were not required to enroll in the trial with a caregiver. Postmortem assessments were completed two months (n = 101) and seven months (n = 97) after the death. A total of 103 caregivers provided data at two months postmortem and/or seven months. ^aPatient became ineligible after consent, but before completing initial assessment. ^bPatient consented but withdrew before completing the initial assessment. VOICE, Values and Options in Cancer Care.