Paul R Duberstein1,2, Paul K Maciejewski3,4, Ronald M Epstein1,5,6,7, Joshua J Fenton8,9,10, Benjamin Chapman1,11, Sally A Norton7,12, Michael Hoerger13,14, Marsha N Wittink1,5, Daniel J Tancredi10,15, Guibo Xing10, Supriya Mohile6,7, Richard L Kravitz9,10,16, Holly G Prigerson4,17. 1. Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York. 2. Department of Health Behavior, Society, and Policy, Rutgers University School of Public Heath, Piscataway, New Jersey. 3. Department of Radiology, Department of Medicine, Weill Cornell Medical College, New York, New York. 4. Cornell Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medical College, New York, New York. 5. Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York. 6. James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York. 7. Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York. 8. Department of Family and Community Medicine, University of California, Davis, Sacramento, California. 9. UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento, California. 10. Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California. 11. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York. 12. School of Nursing, University of Rochester, Rochester, New York. 13. Tulane Cancer Center, Tulane University, New Orleans, Louisiana. 14. Departments of Psychology, Psychiatry, and Medicine, Tulane University, New Orleans, Louisiana. 15. Department of Pediatrics, University of California, Davis, Sacramento, California. 16. Department of Internal Medicine, University of California, Davis, Sacramento, California. 17. Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
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.
RCT Entities:
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.
Entities:
Keywords:
bereavement; cancer; caregiving; communication interventions; patient-physician communication; prolonged grief; purpose in life; satisfaction with care
Authors: Harvey Max Chochinov; Linda J Kristjanson; William Breitbart; Susan McClement; Thomas F Hack; Tom Hassard; Mike Harlos Journal: Lancet Oncol Date: 2011-07-06 Impact factor: 41.316
Authors: Christine Sinsky; Lacey Colligan; Ling Li; Mirela Prgomet; Sam Reynolds; Lindsey Goeders; Johanna Westbrook; Michael Tutty; George Blike Journal: Ann Intern Med Date: 2016-09-06 Impact factor: 25.391
Authors: Rebecca E Ryan; Michael Connolly; Natalie K Bradford; Simon Henderson; Anthony Herbert; Lina Schonfeld; Jeanine Young; Josephine I Bothroyd; Amanda Henderson Journal: Cochrane Database Syst Rev Date: 2022-07-08
Authors: Kah Poh Loh; Enrique Soto Pérez de Celis; Paul R Duberstein; Eva Culakova; Ronald M Epstein; Huiwen Xu; Sindhuja Kadambi; Marie Flannery; Allison Magnuson; Colin McHugh; Kelly M Trevino; Gina Tuch; Erika Ramsdale; Reza Yousefi-Nooraie; Margaret Sedenquist; Jane Jijun Liu; Nataliya Melnyk; Jodi Geer; Supriya G Mohile Journal: Cancer Date: 2020-10-09 Impact factor: 6.921
Authors: Kah Poh Loh; Erin Watson; Eva Culakova; Marie Flannery; Michael Sohn; Huiwen Xu; Sindhuja Kadambi; Allison Magnuson; Colin McHugh; Chandrika Sanapala; Lee Kehoe; Victor G Vogel; Brian L Burnette; Vincent Vinciguerra; Supriya G Mohile; Paul R Duberstein Journal: J Geriatr Oncol Date: 2022-03-08 Impact factor: 3.929
Authors: Natasha Michael; Alex Gorelik; Ekavi Georgousopoulou; Merlina Sulistio; Patrick Tee; Katherine Hauser; David Kissane Journal: Support Care Cancer Date: 2022-05-25 Impact factor: 3.359
Authors: Kah Poh Loh; Huiwen Xu; Ronald M Epstein; Supriya G Mohile; Holly G Prigerson; Sandra Plumb; Susan Ladwig; Sindhuja Kadambi; Melisa L Wong; Colin McHugh; Amy An; Kelly Trevino; Fahad Saeed; Paul R Duberstein Journal: J Pain Symptom Manage Date: 2020-02-13 Impact factor: 5.576