Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.
Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Acta Oncol. 2023 Jul;62(7):803-807. doi: 10.1080/0284186X.2023.2194491. Epub 2023 Apr 3.
The Domus study, a randomized controlled trial (RCT), evaluated the effect of home-based specialized palliative care (SPC) reinforced with a psychological intervention for the patient-caregiver dyad on increasing advanced cancer patients' time spent at home, as opposed to hospitalized, and the number of home deaths. As palliative care extends to include support for patients' families and may thus assist caregivers and decrease demands on them, in this study we evaluated a secondary outcome, caregiver burden. Patients with incurable cancer and their caregivers were randomized (1:1) to care as usual or home-based SPC. Caregiver burden was assessed using the Zarit Burden Interview (ZBI) at baseline and 2, 4, 8 weeks and 6 months after randomization. Intervention effects were assessed in mixed effects models. A total of 258 caregivers were enrolled. Eleven per cent of informal caregivers experienced severe caregiver burden at baseline. Caregiver burden increased significantly over time in both groups ( = 0.0003), but no significant effect of the intervention was seen on overall caregiver burden ( = 0.5046) or burden subscales measuring role and personal strain. In line with the majority of previous RCTs, the Domus intervention was not able to significantly reduce caregiver burden. Future interventions should consider targeting only caregivers reporting the greatest caregiver burden.
多莫斯研究是一项随机对照试验（RCT），评估了强化心理干预的家庭为基础的专业姑息治疗（SPC）对增加晚期癌症患者在家中度过的时间、而不是住院时间和在家中死亡的数量的影响。由于姑息治疗扩展到为患者的家庭提供支持，因此可能会帮助照顾者并减轻他们的需求，在这项研究中，我们评估了次要结果，即照顾者负担。患有不治之症的癌症患者及其照顾者被随机（1:1）分配到常规护理或家庭为基础的 SPC。使用 Zarit 负担访谈（ZBI）在基线和随机分组后 2、4、8 周和 6 个月评估照顾者负担。使用混合效应模型评估干预效果。共纳入 258 名照顾者。11%的非正式照顾者在基线时存在严重的照顾者负担。两组的照顾者负担都随着时间的推移显著增加（ = 0.0003），但干预对整体照顾者负担（ = 0.5046）或衡量角色和个人压力的负担子量表没有显著影响。与大多数先前的 RCT 一样，多莫斯干预措施未能显著减轻照顾者负担。未来的干预措施应考虑仅针对报告最大照顾者负担的照顾者。
