In recent years, the demand for home hospice care has grown rapidly. Family members and friends who act as informal caregivers are essential to the provision of palliative care services;however, this role is not without adverse effects on the caregivers themselves. It is well documented that emotional needs of individuals caring for dying persons in their home are not well attended, and interventions aiming to provide support to informal hospice caregivers are notably lacking. In this context, problem solving therapy (PST) provides an overall coping process that fosters adaptive situational coping and behavioral competence. This reduces and prevents the negative effects of stressful life events with regard to both psychological and physical well-being. We propose a randomized controlled trial to fully evaluate the PST intervention for informal hospice caregivers. Additionally, we aim to evaluate how the modality of the intervention (face to face vs video) impacts its effectiveness. We propose a 4-year randomized trial study in which hospice caregivers will be randomly assigned to a group receiving standard hospice care with the addition of social support visits (attention control group) or a group receiving standard hospice care with the addition of the problem solving intervention delivered face to face (intervention group 1) or a group receiving standard hospice care with the addition of the problem solving intervention delivered via video (intervention group 2).
The specific aims i nclude an assessment of the impact of PST on caregiver quality of life, problem solving ability, caregiver anxiety, and caregiver perceptions. Furthermore, we aim to evaluate the cost effectiveness of the PST intervention.

Public Health Relevance

The proposed research study explores a problem solving intervention that will improve caregivers'quality of life, and cost-effective innovative tools to support its delivery. Thus, the study is highly relevant to public health as it affects the health of a continuously growing segment of our population, namely these who are called to assume the essential role of informal caregiving, and aims to demonstrate the value of a feasible and sustainable problem solving intervention for hospice caregivers.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing and Related Clinical Sciences Study Section (NRCS)
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Mccloskey, Donna J
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University of Washington
Other Health Professions
Schools of Nursing
United States
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Chi, Nai-Ching; Demiris, George; Pike, Kenneth C et al. (2018) Exploring the Challenges that Family Caregivers Faced When Caring for Hospice Patients with Heart Failure. J Soc Work End Life Palliat Care :1-15
Wallace, Audrey S; Parker Oliver, Debra; Demiris, George et al. (2018) The Paradox of Hospice for Caregivers of Cancer Patients. J Pain Symptom Manage 56:e8-e11
Washington, Karla T; Demiris, George; Oliver, Debra Parker et al. (2018) Quality Hospice Care in Adult Family Homes: Barriers and Facilitators. J Am Med Dir Assoc 19:136-140
Tarter, Robin; Demiris, George; Pike, Kenneth et al. (2016) Pain in Hospice Patients With Dementia: The Informal Caregiver Experience. Am J Alzheimers Dis Other Demen 31:524-9
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Washington, Karla T; Pike, Kenneth C; Demiris, George et al. (2015) Gender Differences in Caregiving at End of Life: Implications for Hospice Teams. J Palliat Med 18:1048-53
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Washington, Karla T; Wittenberg-Lyles, Elaine; Oliver, Debra Parker et al. (2014) Rethinking family caregiving: tailoring cognitive-behavioral therapies to the hospice experience. Health Soc Work 39:244-50

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