Family caregivers of patients with advanced cancer are at risk for bereavement- related morbidity. Better communication in the context of cancer care may improve health outcomes of the bereaved.
Aims : In a study nested within a parent RCT (R01CA140419) focused on patient outcomes, we propose to examine whether a health communication intervention can lead to better caregiver mental health (Aim 1) and physical health (Aim 2).
In Aim 3, we seek to contextualize these findings by conducting mediational analyses and qualitative analyses. The former will explore whether intervention effects are mediated by patient-reported quality of life and patient health care utilization. Qualitative methods will be used to link bereavement outcomes with parent study communication outcomes. Design: Multiple waves of caregiver assessments will be added to a NIH-funded two-site cluster RCT. In that study, oncologists are randomized to usual-care (n=15) or the communication intervention (n=15), which involves two in-office sessions providing individually tailored feedback on their patient communication skills. Patients with advanced cancer and their caregivers seen by oncologists in the usual-care arm (n=128 dyads) will receive usual cancer care. Dyads seen by oncologists in the intervention arm (n=128 dyads) will receive pre-visit coaching and question- prompt lists to enhance their communication skills. In this application, we propose to assess caregiver experiences and outcomes while the patients are alive, as well as 2 and 7 months after the patients'deaths. The 2-month post-mortem assessment will include an audiotaped interview to explore caregivers'experiences with key elements of decision-making: information exchange (e.g., tailored), deliberation (e.g. participation), and socioemotional issues (e.g. respect, abandonment). Main outcomes: Prolonged grief symptoms (PG-13) and physical function (SF-36) 7 months following the patients'deaths. Secondary outcomes include symptoms of depression and anxiety, decisional regret, thoughts of suicide, and disability. For the qualitative analyses, criterion based purposeful sampling will be used to make deliberate comparisons linking the parent study and this one based on 3 criteria: intervention arm, communication quality, and prolonged grief. Significance: This efficient addition to an ongoing RCT is the first attempt to examine the effects on bereavement outcomes of an intervention that could be integrated into routine cancer care. As the intervention is systemic, yet simple and readily disseminated, findings will have implications for cancer care, public health, and policy.

Public Health Relevance

Caring for a family member or friend with advanced cancer frequently affects caregivers'own health and well-being. Our team recently received NIH funding to determine whether an innovative health communication intervention for cancer doctors, patients with advanced cancer and their caregivers improves patients'quality of life. The proposed study will expand the focus to determine whether that intervention will have enduring, positive effects on the mental and physical health of family and friend caregivers after the patients have died. This is the first study to examine the effects on caregivers of an intervention that could potentially be readily integrated into ongoing, routine cancer care.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
1R01CA168387-01A1
Application #
8451053
Study Section
Nursing and Related Clinical Sciences Study Section (NRCS)
Program Officer
Chou, Wen-Ying
Project Start
2013-01-23
Project End
2017-12-31
Budget Start
2013-01-23
Budget End
2013-12-31
Support Year
1
Fiscal Year
2013
Total Cost
$529,238
Indirect Cost
$117,444
Name
University of Rochester
Department
Psychiatry
Type
Schools of Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Fox, Rina S; Lillis, Teresa A; Gerhart, James et al. (2018) Multiple Group Confirmatory Factor Analysis of the DASS-21 Depression and Anxiety Scales: How Do They Perform in a Cancer Sample? Psychol Rep 121:548-565
Trevino, Kelly M; Maciejewski, Paul K; Shen, Megan Johnson et al. (2018) How much time is left? Associations between estimations of patient life expectancy and quality of life in patients and caregivers. Support Care Cancer :
Kurita, Keiko; Siegler, Eugenia L; Reid, M Cary et al. (2018) It Is Not What You Think: Associations Between Perceived Cognitive and Physical Status and Prognostic Understanding in Patients With Advanced Cancer. J Pain Symptom Manage 56:259-263
Fenton, Joshua J; Duberstein, Paul R; Kravitz, Richard L et al. (2018) Impact of Prognostic Discussions on the Patient-Physician Relationship: Prospective Cohort Study. J Clin Oncol 36:225-230
Norton, S A; Wittink, M N; Duberstein, P R et al. (2018) Family caregiver descriptions of stopping chemotherapy and end-of-life transitions. Support Care Cancer :
Duberstein, Paul R; Chen, Michael; Chapman, Benjamin P et al. (2018) Fatalism and educational disparities in beliefs about the curability of advanced cancer. Patient Educ Couns 101:113-118
Saeed, Fahad; Hoerger, Michael; Norton, Sally A et al. (2018) Preference for Palliative Care in Cancer Patients: Are Men and Women Alike? J Pain Symptom Manage 56:1-6.e1
Epstein, Ronald M; Duberstein, Paul R; Fenton, Joshua J et al. (2017) Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer: The VOICE Randomized Clinical Trial. JAMA Oncol 3:92-100
Rodenbach, Rachel A; Brandes, Kim; Fiscella, Kevin et al. (2017) Promoting End-of-Life Discussions in Advanced Cancer: Effects of Patient Coaching and Question Prompt Lists. J Clin Oncol 35:842-851
Hoerger, Michael; Perry, Laura M; Gramling, Robert et al. (2017) Does educating patients about the Early Palliative Care Study increase preferences for outpatient palliative cancer care? Findings from Project EMPOWER. Health Psychol 36:538-548

Showing the most recent 10 out of 15 publications