Family Caregiver Depressive Symptom and Grief Outcomes From the ENABLE III Randomized Controlled Trial.
Little is known about whether early palliative care (EPC) support for family caregivers (CGs) impacts depressive symptoms and grief after care recipients die.



To assess after-death CG depressive symptom and grief scores for early compared to delayed group CGs.



We conducted a randomized controlled trial (10/2010-9/2013) of an EPC telehealth intervention for CGs (n = 123) initiated at the time of care recipients' advanced cancer diagnosis (early group) or 12 weeks later (delayed group) in a rural comprehensive cancer center, affiliated clinics, and a Veterans Administration medical center. The ENABLE [Educate, Nurture, Advise, Before Life Ends] CG intervention consisted of three weekly sessions, monthly follow-up, and a bereavement call. CGs completed the Center for Epidemiological Study-Depression (CES-D) scale and the Prigerson Inventory of Complicated Grief-Short Form (PG13) 8-12 weeks after care recipients' deaths. Crude and covariate-adjusted between-group differences were estimated and tested using general linear models.



For care recipients who died (n = 70), 44 CGs (early: n = 19; delayed: n = 25) completed after-death questionnaires. Mean depressive symptom scores (CES-D) for the early group was 14.6 (SD = 10.7) and for the delayed group was 17.6 (SD = 11.8). Mean complicated grief scores (PG13) for the early group was 22.7 (SD = 4.9) and for the delayed group was 24.9 (SD = 6.9). Adjusted between-group differences were not statistically significant (CES-D: d = 0.07, P = 0.88; PG13: d = -0.21, P = 0.51).



CGs' depressive symptom and complicated grief scores 8-12 weeks after care recipients' deaths were not statistically different based on the timing of EPC support. The impact of timing of CG EPC interventions on CGs bereavement outcomes requires further investigation.
School of Nursing, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Nicholas
JN
Dionne-Odom
School of Nursing, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Andres
A
Azuero
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Kathleen D
KD
Lyons
Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA.
Jay G
JG
Hull
Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA.
Anna T
AT
Prescott
Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA.
Tor
T
Tosteson
Department of Medicine, Hematology/Oncology, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, New Hampshire, USA.
Jennifer
J
Frost
Department of Medicine, Hematology/Oncology, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, New Hampshire, USA.
Konstantin H
KH
Dragnev
School of Nursing, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Electronic address: mbakitas@uab.edu.
Marie A
MA
Bakitas
D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000209:etiology*; D005190:Family / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011569:Psychiatric Status Rating Scales; D016037:Single-Blind Method; D017216:Telemedicine; D013997:Time Factors
Family caregiving; advanced cancer; palliative care; telehealth