Reduced Family Caregiver Depression With Early vs Delayed Palliative Care Intervention for Caregivers


Key Points

  • Early initiation of a palliative care intervention for caregivers was associated with lower depression scores at 3 months.
  • Early intervention was associated with reduced depression score and reduced caregiver stress burden among caregivers whose care recipients died.

In the ENABLE III study reported in the Journal of Clinical Oncology, Dionne-Odom et al found that early vs delayed use of a palliative care intervention for family caregivers of patients with advanced cancer reduced caregiver depression scores and caregiver stress burden. No differences in caregiver quality of life were observed.

Study Details

The study involved 122 caregivers of patients with advanced cancer, who were randomly assigned between October 2010 and March 2013 to receive three structured weekly telephone coaching sessions, monthly follow-up, and a bereavement call either early after enrollment (n = 61) or 3 months later (n = 61). Patient participants were from the Norris Cotton Cancer Center, affiliated outreach clinics, and the VA Medical Center situated in New Hampshire and Vermont. Outcomes were compared between the early and delayed groups prior to the start of the intervention in the delayed group. An additional terminal-decline analysis used only data from the last 36 weeks of care recipient life for caregivers whose care recipient had died. Caregiver average age was 60 years, and most were female (79%) and white (93%).

Quality of life was measured using the caregiver Quality of Life Scale-Cancer (CQOL-C, range = 0–140, higher equals worse). Depression was measured using the Center for Epidemiologic Study-Depression (CESD) Scale (range = 0–60, higher equals worse). Caregiver burden was measured using the Montgomery-Borgatta Caregiver Burden scale, which includes objective, demand, and stress burden subscales. High objective burden score (range = 6–30) suggests interference with caregiver private, social, and recreational time and normal daily routine; high demand burden score (range = 4–20) indicates that the caregiver feels overstrained by caregiving demands; high stress burden score (range = 4–20) indicates strained emotional demands.

Lower Depression Scores

Between-group differences in depression scores from enrollment to 3 months (ie, before the delayed group started the intervention) favored the early group (mean difference = −3.4, d = −.32, P = .02). There were no differences in caregiver quality of life (mean difference = −2, d = −.13, P = .39) or caregiver burden (objective burden mean difference = 0.3, d = .09, P = .64; stress burden mean difference = −.5, d = −.2, P = .29; demand burden mean difference = 0, d = -.01, P = .97).

The terminal decline analysis of data from decedents’ caregivers indicated between-group differences favoring the early group for depression (mean difference = −3.8, d = −.39, P = .02) and stress burden (mean difference = −1.1, d = -.44, P = .01) but not for quality of life (mean difference = −4.9, d = −.3,  P = .07) or other caregiver burden (objective burden mean difference = −.6, d = −.18, P = .27; demand burden mean difference = −.7,  d = −.23, P = .22).

The investigators concluded: “Early-group [caregivers] had lower depression scores at 3 months and lower depression and stress burden in the terminal decline analysis. Palliative care for [caregivers] should be initiated as early as possible to maximize benefits.”

Marie A. Bakitas, DNSc, CRNP, of University of Alabama at Birmingham, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported in part by grants from the National Institute for Nursing Research, National Institutes of Health, and American Cancer Society.

Mark T. Hegel, PhD, reported research funding from Johnson & Johnson.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.