title: Dyadic psychological intervention for patients with cancer and caregivers in home-based specialized palliative care: The Domus model.
abstract: ABSTRACTObjective:Patients with incurable cancer and their informal caregivers have numerous psychological and psychosocial needs. Many of these patients wish to receive their care and die at home. Few home-based specialized palliative care (SPC) interventions systematically integrate psychological support. We present a psychological intervention for patient-caregiver dyads developed for an ongoing randomized controlled trial (RCT) of home-based SPC, known as Domus, as well as the results of an assessment of its acceptability and feasibility.
  
  
  
  The Domus model of SPC for patients with incurable cancer and their caregivers offered systematic psychological assessment and dyadic intervention as part of interdisciplinary care. Through accelerated transition to SPC, the aim of the model was to enhance patients' chances of receiving care and dying at home. Integration of psychological support sought to facilitate this goal by alleviating distress in patients and caregivers. Psychologists provided needs-based sessions based on existential-phenomenological therapy. Feasibility and acceptability were investigated by examining enrollment, nonparticipation, and completion of psychological sessions.
  
  
  
  Enrollment in the RCT and uptake of the psychological intervention indicated that it was feasible and acceptable to patients and caregivers. The strengths of the intervention included its focus on dyads, psychological distress, and existential concerns, as well as interdisciplinary collaboration and psychological interventions offered according to need. Its main limitation was a lack of an intervention for other family members.
  
  
  
  Our results show that psychological intervention can be systematically integrated into SPC and that it appears feasible to provide dyadic needs-based sessions with an existential therapeutic approach. The Domus RCT will provide evidence of the efficacy of a novel model of multidisciplinary SPC.
authors.affiliation: Danish Cancer Society Research Center,Copenhagen,Denmark.
authors.forename: Annika B
authors.initials: AB
authors.lastname: von Heymann-Horan
authors.affiliation: Department of Psychology,University of Copenhagen,Copenhagen,Denmark.
authors.forename: Louise B
authors.initials: LB
authors.lastname: Puggaard
authors.affiliation: Department of Psychology,University of Copenhagen,Copenhagen,Denmark.
authors.forename: Kathrine G
authors.initials: KG
authors.lastname: Nissen
authors.affiliation: Palliative Research Group,Department of Oncology,Rigshospitalet, Copenhagen University Hospital,Copenhagen,Denmark.
authors.forename: Kirstine Skov
authors.initials: KS
authors.lastname: Benthien
authors.affiliation: Danish Cancer Society Research Center,Copenhagen,Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Bidstrup
authors.affiliation: Department of Psychiatry,University of Pennsylvania School of Medicine,Philadelphia,Pennsylvania,USA.
authors.forename: James
authors.initials: J
authors.lastname: Coyne
authors.affiliation: Danish Cancer Society Research Center,Copenhagen,Denmark.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.affiliation: KORA,The Danish Institute for Local and Regional Government Research,Copenhagen,Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Kjellberg
authors.affiliation: Palliative Research Group,Department of Oncology,Rigshospitalet, Copenhagen University Hospital,Copenhagen,Denmark.
authors.forename: Mie
authors.initials: M
authors.lastname: Nordly
authors.affiliation: Palliative Research Group,Department of Oncology,Rigshospitalet, Copenhagen University Hospital,Copenhagen,Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Sjøgren
authors.affiliation: Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark,Copenhagen,Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Timm
authors.affiliation: Department of Oncology,Rigshospitalet, Copenhagen University Hospital,Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: von der Maase
authors.affiliation: Research Unit for General Practice, Aarhus University,Aarhus,Denmark.
authors.forename: Mai-Britt
authors.initials: MB
authors.lastname: Guldin
mesh_terms: D017028:Caregivers / Q000523:psychology*; D002985:Clinical Protocols / Q000592:standards; D006699:Home Care Services / Q000639:trends*; D006801:Humans; D009369:Neoplasms / Q000523:psychology / Q000628:therapy; D010361:Patients / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy*
keywords: Cancer; Existential therapy; Family caregiver; Palliative care; Psychological intervention