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Early palliative care improves satisfaction with care among caregivers
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Caregivers of patients with advanced cancers demonstrated higher satisfaction with care after early palliative care referrals, according to a cluster-randomized trial.
Although initially delivered as end-of-life care, physicians have recommended palliative care be given earlier in the disease course of advanced cancers.
“The early palliative care approach aims to improve patients’ symptoms, attend to advance care planning, and assess and manage psychosocial needs of the patient and family,” Camilla Zimmermann, MD, PhD, FRCPC, senior scientist at the Princess Margaret Cancer Centre in Toronto, and colleagues wrote. “This approach has the potential to improve caregivers’ quality of life and satisfaction with care through holistic care of patients and their caregivers.”
However, studies evaluating caregiver outcomes have been scarce with mixed results.
Therefore, Zimmermann and colleagues compared satisfaction and quality-of-life outcomes in 151 caregivers of patients with advanced cancer who received early palliative care (n = 77) or were referred to standard oncology care, with palliative care assigned as needed (n = 74).
Researchers assessed satisfaction with care among caregivers using the FAMCARE-19 scale and quality of life using the SF-36v2 Health Survey — which includes a mental component score (MCS) and physical component score (PCS) — and Caregiver QOL Index-Cancer (CQOL-C). These measures were assessed at baseline and monthly for 4 months at 24 medical oncology clinics.
Caregivers tended to be female and married to the patient, and they spent approximately 3 hours per day on caregiving tasks.
Satisfaction with care improved in the palliative intervention group compared with the control arm over 3 months (P = .007) and 4 months (P = .02).
The researchers also conducted an exploratory analysis to determine which items within the FAMCARE-19 scale demonstrated the most improvement over 3 months in the intervention arm. Results showed greater satisfaction with:
- how thoroughly the doctor assessed the patients’ symptoms (P = .004);
- availability of nurses to the family (P = .01);
- information about the patients’ test (P = .02); and
- referrals to other specialists (P = .02).
“These results complement our previously reported findings that early palliative care improved quality of life and satisfaction with care in patients, highlighting the shared experience of living with advanced cancer among patients and their caregivers, and adding to the body of evidence supporting early palliative care in the context of a diagnosis of advanced cancer,” the researchers wrote.
However, no statistically significant difference appeared over 3 months or 4 months between the intervention and control groups on the CQOL-C, SF-36 PCS and SF-36 MCS scales.
Zimmermann and colleagues suggested ongoing active investigation of quality-of-life outcomes should be conducted.
“Refining measures of quality of life may enhance their sensitivity to detect the impact of an intervention,” they added. “In addition, identifying which caregivers are most at risk [for] distress and burden could help direct more extensive and potentially costly caregiver-specific interventions to those with the greatest need.” – by Kristie L. Kahl
Disclosure: The researchers report no relevant financial disclosures.
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