Hospice care is conceptualized as quality compassionate care for people facing a life-limiting illness, with services that cover clinical care, pain management, and emotional and spiritual support tailored to patients' and families' needs and preferences. Family members, spouses, friends or others who assume the unpaid or informal caregiving role are essential to the delivery of hospice services; however, stress and caregiver burden can negatively affect caregivers' morbidity and mortality. The emotional needs of individuals caring for dying persons at home are not well attended, and interventions aiming to provide support to hospice caregivers are notably lacking. Our team recently completed a randomized clinical trial (Grant Nr. R01NR012213) with 514 hospice caregivers to test a problem-solving therapy (PST) intervention we tailored specifically for the hospice setting, entitled PISCES (Problem-solving Intervention to Support Caregivers in End of Life care Settings). Our findings demonstrate that the PISCES intervention when delivered face to face was effective leading to statistically significant decrease in anxiety and increase in quality of life when compared to the other groups (video group and attention control). An additional lesson learned from our RCT study is that caregivers wanted to focus not only on specific problems or challenges, but also on recognizing the positive aspects of caregiving. This approach of positive reappraisal has been found to enhance problem solving interventions in other settings.
The specific aims of this renewal application are: 1) to compare the effectiveness of the PISCES intervention when delivered face to face and when delivered in a hybrid platform (with the first session in person and remaining sessions via video) to hospice caregivers; 2) to compare the effectiveness of the PISCES intervention to the refined PISCES intervention (PISCESplus) that integrates positive reappraisal elements; 3) to assess caregivers' perceptions of and satisfaction with the PISCESplus intervention; and 4) to conduct a cost analysis of the three intervention groups.

Public Health Relevance

The proposed research study explores the delivery a problem solving intervention that aims to reduce caregiver anxiety and depression and improve quality of life, investigating tools that will facilitate a cost-saving delivery and maximize its effectiveness. 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)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-NRCS-V (08)F)
Program Officer
Kehl, Karen
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Washington
Other Health Professions
Schools of Nursing
United States
Zip Code
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
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
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
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
Albright, David L; Oliver, Debra Parker; Demiris, George (2015) Reaction to Caregiving by Hospice Caregivers Upon Enrollment. Am J Hosp Palliat Care 32:641-6
Washington, Karla T; Demiris, George; Pike, Kenneth C et al. (2015) Anxiety among informal hospice caregivers: an exploratory study. Palliat Support Care 13:567-73
Washington, Karla T; Pike, Kenneth C; Demiris, George et al. (2015) Unique characteristics of informal hospice cancer caregiving. Support Care Cancer 23:2121-8
Chi, Nai-Ching; Demiris, George (2015) A systematic review of telehealth tools and interventions to support family caregivers. J Telemed Telecare 21:37-44
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

Showing the most recent 10 out of 13 publications