Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco (W.S.), San Francisco, California, USA.
University of Pittsburgh School of Medicine (A.D.A., Y.S.), Pittsburgh, Pennsylvania, USA.
J Pain Symptom Manage. 2023 Mar;65(3):173-182. doi: 10.1016/j.jpainsymman.2022.11.025. Epub 2022 Dec 9.
Palliative care offers patient and family centered approaches that may mitigate risk of caregiver burden and poor mood.
To determine whether a palliative care intervention (CONNECT) improved burden, mood, and self-efficacy among caregivers of patients with advanced cancer.
In this cluster randomized trial, patients and their caregivers were recruited from 17 Oncology clinics in Pennsylvania. Participants attended nurse-led monthly visits, addressing patient symptoms, goals of care, and advance care planning. At baseline and three months, we measured caregiver burden using Zarit Burden Interview (ZBI-12; range 0-48), caregiver anxiety and depression using Hospital Anxiety and Depression Scales (HADS-A, range 0-21; HADS-D, range 0-21). We measured caregiver self-efficacy at three months using Caregiver Inventory (CGI; range 0-189).
We enrolled 441 caregivers and 381 completed three-month assessments. We found no significant differences in caregiver burden (adjusted mean difference -0.39; 95% CI -1.07-0.29, P = 0.90), depression (adjusted mean difference -0.22, 95% CI -0.97-0.55, P = 0.26), or anxiety (adjusted mean difference 0.09; 95% CI -1.25-1.43, P = 0.58), between the intervention and standard care at three months. Caregiver self-efficacy was higher at three months in the intervention compared to standard care (adjusted mean difference 9.36; 95% CI 0.95-17.77, P = 0.030).
Caregivers in CONNECT did not experience improved burden or mood, however, they reported higher self-efficacy compared to caregivers receiving standard care. This study highlights the need for strategies to optimize caregiver outcomes in palliative care interventions.
姑息治疗提供以患者和家庭为中心的方法，可能减轻照顾者负担和不良情绪的风险。
确定姑息治疗干预（CONNECT）是否改善了晚期癌症患者照顾者的负担、情绪和自我效能感。
在这项聚类随机试验中，从宾夕法尼亚州的 17 个肿瘤诊所招募了患者及其照顾者。参与者参加了护士主导的每月就诊，解决患者的症状、护理目标和预先护理计划。在基线和三个月时，我们使用照顾者负担量表（Zarit Burden Interview，ZBI-12；范围 0-48）、照顾者焦虑和抑郁量表（Hospital Anxiety and Depression Scales，HADS-A，范围 0-21；HADS-D，范围 0-21）来测量照顾者的负担。我们在三个月时使用照顾者量表（Caregiver Inventory，CGI；范围 0-189）来测量照顾者的自我效能感。
我们招募了 441 名照顾者，其中 381 名完成了三个月的评估。我们发现，在照顾者负担（调整后的平均差异 -0.39；95%置信区间 -1.07-0.29，P=0.90）、抑郁（调整后的平均差异 -0.22，95%置信区间 -0.97-0.55，P=0.26）或焦虑（调整后的平均差异 0.09；95%置信区间 -1.25-1.43，P=0.58）方面，干预组与标准护理组在三个月时没有显著差异。与接受标准护理的照顾者相比，干预组在三个月时的自我效能感更高（调整后的平均差异 9.36；95%置信区间 0.95-17.77，P=0.030）。
CONNECT 中的照顾者没有改善负担或情绪，但与接受标准护理的照顾者相比，他们报告自我效能感更高。这项研究强调了在姑息治疗干预中需要采取策略来优化照顾者的结果。
