J Nicholas Odom, Andres Azuero, Richard A Taylor, Jennifer Young Pierce, Chelsea L McGowen, Maria Pisu, Gabrielle Rocque, Rhiannon D Reed, Rachel Wells, Shena Gazaway, Sarah Mollman, Rushil V Patel, Macy L Stockdill, Sylvia Huang, Sally Engler, Marie A Bakitas
This caregiver-focused early palliative care intervention produced significant long-term patient benefits in a trial enrolling African American and rural-dwelling caregivers, including lower patient depressive symptoms and better physical QOL. Caregiver effects were more limited, although demand burden improved. These findings support scalable caregiver-focused palliative care strategies for populations facing barriers to specialty supportive care.
BACKGROUND: African American and rural-dwelling family caregivers of patients with advanced cancer may face structural, geographic, transportation, and access barriers to supportive care. Evidence is limited regarding the long-term effects of early palliative care interventions designed for these populations.
METHODS: We examined 36 and 48 week outcome data from 222 caregivers and 165 patients who participated in a single-blind, multi-site randomized clinical trial (intervention vs. usual care) of a lay-coach-led, caregiver-focused early palliative care intervention ENABLE Cornerstone (January 2020-November 2025). Caregiver and patient anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]), quality of life (QOL) (PROMIS Global Health 10), and caregiver burden (Montgomery-Borgatta Caregiver Burden scales [MBCB]) at 36 and 48 weeks were examined using baseline-constrained linear mixed effects models with participant and intervention-coach random effects.
RESULTS: Intervention caregivers reported lower demand burden compared with usual care at 36 weeks (mean [SE] difference = -1.54 [0.52]; Cohen's d = -0.41 [95% CI, -0.68, -0.13]; adjusted p=.03). Intervention patients demonstrated significantly lower depressive symptoms at 36 weeks (mean [SE] difference = -1.53 [0.61]; Cohen's d = -0.38 [95% CI, -0.67, -0.08]; adjusted p=.048) and better physical quality of life at 48 weeks (mean [SE] difference=3.93 [1.38]; Cohen's d = 0.46 [95% CI, 0.14, 0.78]; adjusted p=.02).
CONCLUSIONS: This caregiver-focused early palliative care intervention produced significant long-term patient benefits in a trial enrolling African American and rural-dwelling caregivers, including lower patient depressive symptoms and better physical QOL. Caregiver effects were more limited, although demand burden improved. These findings support scalable caregiver-focused palliative care strategies for populations facing barriers to specialty supportive care.
CLINICALTRIALS.GOV IDENTIFIER: NCT04318886.