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

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.