Telehealth intervention for family caregivers in HF shows limited short-term benefit
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A telehealth intervention for family caregivers of patients with advanced HF that addressed quality of life, mood and burden did not demonstrate clinically better outcomes compared with no intervention.
The investigators attributed the lack of change to most family caregivers included in the randomized clinical trial were not distressed at baseline.
According to a study published in JAMA Network Open, the task of being a family caregiver to a loved one with advanced HF, with little to no training, has been associated with elevated physical and psychological distress and low quality of life for the caregiver.
For this trial, participants (mean age, 58 years; 85% women; 52% black; 65% were spouse or partner) were enrolled in four weekly 20-to-60-minute psychosocial and problem-solving telehealth sessions led by a trained nurse coach. Quality of life was measured using the Bakas Caregiving Outcomes Scale; anxiety and/or depressive symptoms were measured using the Hospital Anxiety and Depression Scale; and burden was measured using the Montgomery-Borgatta Caregiver Burden scales during a 16-week period. The usual care arm received no intervention.
Researchers observed that the mean Bakas Caregiving Outcomes Scale score improved 0.7 points in the telehealth group and 1.1 points in the usual care group (difference, −0.4; 95% CI, −5.1 to 4.3; Cohen d = −0.03).
Moreover, there were no relevant differences between the telehealth intervention and usual care arms for the Hospital Anxiety and Depression Scale anxiety measure (mean improvement, 0.3 for intervention vs. 0.4 for usual care; difference, −0.1; Cohen d = −0.02) or depression measure (mean improvement, −0.2 for intervention vs. −0.3 for usual care; difference, 0.1; Cohen d = 0.03).
Additionally, there were no between-group differences in the Montgomery-Borgatta Caregiver Burden scales (Cohen d range, −0.18 to 0) and differences in secondary outcomes including global health and positive aspects of caregiving were also nonsignificant (Cohen d range, −0.22 to 0).
“Unfortunately, we did not see any differences between the intervention group and the usual care group over 16 weeks with the outcomes that we had, which included quality of life; depression and anxiety symptoms; and their global physical health,” J. Nicholas Dionne-Odom, PhD, APRN, assistant professor at the University of Alabama at Birmingham School of Nursing, told Healio. “What this means for clinicians is that support that they can give to these family members really should be targeted at those who are the most distressed. They're the most likely to benefit, but I really can't make any strong clinical recommendations based off the kind of support that we delivered, unfortunately, but I think it certainly points towards future direction.”
Reasons for lack of benefit
“A plausible explanation for the lack of intervention effect was that our cohort of family caregivers was not distressed nor experiencing poor quality of life,” the researchers wrote. “Hence, our intervention had no room to improve the distress and quality of life of these individuals, resulting in a possible floor effect. Furthermore, slightly more than half of the sample was African American, a population that has been observed in prior studies to have lower levels of distress and higher quality of life compared with white populations (despite reporting higher levels of caregiving intensity).”
The researchers also theorized that the reason for the lack of treatment benefit could be attributed to only a small proportion (60%) of family caregivers in the intervention group completed all four intervention sessions. With approximately 40% of the treatment group not completing the intervention, the intervention itself may be burdensome for the caregivers, the researchers wrote.
Future research
“There may be beneficial long term effects that we weren't able to see with a 16 week analysis, which is to say, some of the benefits of early palliative care, including advanced care planning, one might not see that positive impact until we look closer towards end of life,” Dionne-Odom said in an interview. “Very few patients died in this study, despite the fact that they had advanced heart failure. That's another question. Maybe we looked too close in time to when we delivered this type of support. The fact might be that the support shows benefit later on. We just couldn't see it.
“There was actually a parallel intervention here for patients and we're doing analyses now to see if what we did for caregivers actually had a parallel benefit on patients,” Dionne-Odom told Healio. “Going forward, interventions in this heart failure space should really additionally focus on patient outcomes as an indicator of what type of support we can deliver to these family members.” – by Scott Buzby
Disclosures: Dionne-Odom reports he received grants from the National Institute of Nursing Research and the National Palliative Care Research Center during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.
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