title: The feasibility and acceptability of a chaplain-led intervention for caregivers of seriously ill patients: A Caregiver Outlook pilot study.
abstract: When caring for a loved one with a life-limiting illness, a caregiver's own physical, emotional, and spiritual suffering can be profound. While many interventions focus on physical and emotional well-being, few caregiver interventions address existential and spiritual needs and the meaning that caregivers ascribe to their role. To evaluate the feasibility and acceptability of the process and content of Caregiver Outlook, we employed a manualized chaplain-led intervention to improve well-being by exploring role-related meaning among caregivers of patients with a life-limiting illness.
  
  
  
  We conducted a single-arm pre-post pilot evaluation among caregivers of patients with advanced cancer or amyotrophic lateral sclerosis (ALS). Caregivers completed three chaplain-led intervention sessions focusing on (1) a relationship review, (2) forgiveness, and (3) legacy. Outcomes administered at baseline and at 1 and 2 weeks after the intervention included quality of life, anxiety, depression, spiritual well-being, religious coping, caregiver burden, and grief.
  
  
  
  The sample (N = 31) included a range of socioeconomic status groups, and the average age was approximately 60 years. A third of them worked full-time. Some 74% of our participants cared for a spouse or partner, and the other quarter of the sample cared for a parent (13%), child (10%), or other close family member (3%). At baseline, participants did not demonstrate clinical threshold levels of anxiety, depression, or other indicators of distress. Outcomes were stable over time. The qualitative results showed the ways in which Caregiver Outlook was assistive: stepping back from day-to-day tasks, the opportunity to process emotions, reflecting on support received, provoking thoughts and emotions between sessions, discussing role changes, stimulating communication with others, and the anonymity of a phone conversation. Both religious and nonreligious participants were pleased with administration of the chaplain intervention.
  
  
  
  The acceptability and feasibility of Caregiver Outlook were demonstrated among caregivers of patients with an advanced illness. Our pilot findings suggest minor modifications to study participant screening, interventionist guidance, and the study measures.
authors.affiliation: Duke Palliative Care,Department of Medicine,Duke University School of Medicine,Durham,North Carolina.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Steinhauser
authors.affiliation: Pastoral Services,Duke University Hospital,Durham,North Carolina.
authors.forename: Annette
authors.initials: A
authors.lastname: Olsen
authors.affiliation: Duke Palliative Care,Department of Medicine,Duke University School of Medicine,Durham,North Carolina.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Johnson
authors.affiliation: Division of General Internal Medicine,Duke University School of Medicine,Durham,North Carolina.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Sanders
authors.affiliation: Department of Biostatistics and Informatics,Duke University School of Medicine,Durham,North Carolina.
authors.forename: Maren
authors.initials: M
authors.lastname: Olsen
authors.affiliation: School of Nursing,Duke University School of Medicine,Durham,North Carolina.
authors.forename: Natalie
authors.initials: N
authors.lastname: Ammarell
authors.affiliation: Durham VA Medical Center,Division of Pulmonary Medicine,Cincinnati Children's Hospital Medical Center,Cincinnati,Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossoehme
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D002977:Clergy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010865:Pilot Projects; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy; D019452:Terminally Ill / Q000523:psychology; D000078329:Workforce
keywords: Intervention; Quality of Life; Spirituality