title: Benefits of Early Versus Delayed Palliative Care to Informal Family Caregivers of Patients With Advanced Cancer: Outcomes From the ENABLE III Randomized Controlled Trial.
abstract: OBJECTIVE
  To determine the effect of early versus delayed initiation of a palliative care intervention for family caregivers (CGs) of patients with advanced cancer.
  
  
  METHODS
  Between October 2010 and March 2013, CGs of patients with advanced cancer were randomly assigned to receive three structured weekly telephone coaching sessions, monthly follow-up, and a bereavement call either early after enrollment or 3 months later. CGs of patients with advanced cancer were recruited from a National Cancer Institute cancer center, a Veterans Administration Medical Center, and two community outreach clinics. Outcomes were quality of life (QOL), depression, and burden (objective, stress, and demand).
  
  
  RESULTS
  A total of 122 CGs (early, n = 61; delayed, n = 61) of 207 patients participated; average age was 60 years, and most were female (78.7%) and white (92.6%). Between-group differences in depression scores from enrollment to 3 months (before delayed group started intervention) favored the early group (mean difference, -3.4; SE, 1.5; d = -.32; P = .02). There were no differences in QOL (mean difference, -2; SE, 2.3; d = -.13; P = .39) or burden (objective: mean difference, 0.3; SE, .7; d = .09; P = .64; stress: mean difference, -.5; SE, .5; d = -.2; P = .29; demand: mean difference, 0; SE, .7; d = -.01; P = .97). In decedents' CGs, a terminal decline analysis indicated between-group differences favoring the early group for depression (mean difference, -3.8; SE, 1.5; d = -.39; P = .02) and stress burden (mean difference, -1.1; SE, .4; d = -.44; P = .01) but not for QOL (mean difference, -4.9; SE, 2.6; d = -.3; P = .07), objective burden (mean difference, -.6; SE, .6; d = -.18; P = .27), or demand burden (mean difference, -.7; SE, .6; d = -.23; P = .22).
  
  
  CONCLUSIONS
  Early-group CGs had lower depression scores at 3 months and lower depression and stress burden in the terminal decline analysis. Palliative care for CGs should be initiated as early as possible to maximize benefits.
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: J Nicholas
authors: JN
authors: Dionne-Odom
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Andres
authors: A
authors: Azuero
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Kathleen D
authors: KD
authors: Lyons
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Jay G
authors: JG
authors: Hull
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Tor
authors: T
authors: Tosteson
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Zhigang
authors: Z
authors: Li
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Zhongze
authors: Z
authors: Li
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Jennifer
authors: J
authors: Frost
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Konstantin H
authors: KH
authors: Dragnev
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Imatullah
authors: I
authors: Akyar
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors: Mark T
authors: MT
authors: Hegel
authors: J. Nicholas Dionne-Odom, Andres Azuero, Imatullah Akyar, and Marie A. Bakitas, University of Alabama at Birmingham, Birmingham, AL; Kathleen D. Lyons, Jay G. Hull, Zhigang Li, and Mark T. Hegel, Dartmouth College; Tor Tosteson and Zhongze Li, Norris Cotton Cancer Center, Hanover; and Jennifer Frost and Konstantin H. Dragnev, Dartmouth-Hitchcock Medical Center, Lebanon, NH. mbakitas@uab.edu.
authors: Marie A
authors: MA
authors: Bakitas
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003376:Counseling; D003863:Depression / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D017216:Telemedicine; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome