An Early Palliative Care Telehealth Coaching Intervention to Enhance Advanced Cancer Family Caregivers' Decision Support Skills: The CASCADE Pilot Factorial Trial

J Nicholas Dionne-Odom; Rachel D Wells; Kate Guastaferro; Andres Azuero; Bailey A Hendricks; Erin R Currie; Avery Bechthold; Chinara Dosse; Richard Taylor; Rhiannon D Reed; Erin R Harrell; Shena Gazaway; Sally Engler; Peg McKie; Grant R Williams; Rebecca Sudore; Christine Rini; Abby R Rosenberg; Marie A Bakitas

doi:10.1016/j.jpainsymman.2021.07.023

An Early Palliative Care Telehealth Coaching Intervention to Enhance Advanced Cancer Family Caregivers' Decision Support Skills: The CASCADE Pilot Factorial Trial

J Pain Symptom Manage. 2022 Jan;63(1):11-22. doi: 10.1016/j.jpainsymman.2021.07.023. Epub 2021 Jul 31.

Authors

J Nicholas Dionne-Odom¹, Rachel D Wells², Kate Guastaferro³, Andres Azuero², Bailey A Hendricks², Erin R Currie², Avery Bechthold², Chinara Dosse², Richard Taylor², Rhiannon D Reed⁴, Erin R Harrell⁵, Shena Gazaway², Sally Engler², Peg McKie², Grant R Williams⁶, Rebecca Sudore⁷, Christine Rini⁸, Abby R Rosenberg⁹, Marie A Bakitas¹⁰

Affiliations

¹ School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA. Electronic address: dionneod@uab.edu.
² School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA.
³ Methodology Center, Pennsylvania State University (K.G.), University Park, Pennsylvania, USA.
⁴ Comprehensive Transplant Institute, University of Alabama at Birmingham (R.D.R.), Birmingham, Alabama, USA.
⁵ Department of Psychology, University of Alabama (E.R.H.), Tuscaloosa, Alabama, USA.
⁶ School of Medicine, Division of Hematology-Oncology, University of Alabama at Birmingham (G.R.W.), Birmingham, Alabama, USA.
⁷ School of Medicine, Division of Geriatrics, University of California (R.S.), San Francisco, California, USA.
⁸ Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University (C.R.), Chicago, Illinois, USA.
⁹ Division of Hematology-Oncology, Department of Pediatrics, School of Medicine, University of Washington (A.R.R.), Seattle, Washington, USA; Palliative Care and Resilience Lab, Seattle Children's Research Institute (A.R.R.), Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington (A.R.R.), Seattle, Washington, USA.
¹⁰ School of Nursing, University of Alabama at Birmingham (J.N.D.O., R.D.W., A.A., B.A.H., E.R.C., A.B., C.D., R.T., S.G., S.E., P.M., M.A.B.), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA; Center for Palliative and Supportive Care, University of Alabama at Birmingham (J.N.D.O., M.A.B.), Birmingham, Alabama, USA.

Abstract

Context: Patients with advanced cancer often involve family caregivers in health-related decision-making from diagnosis to end-of-life; however, few interventions have been developed to enhance caregiver decision support skills.

Objectives: Assess the feasibility, acceptability, and potential efficacy of individual intervention components of CASCADE (CAre Supporters Coached to be Adept DEcision Partners), an early telehealth, palliative care coach-led decision support training intervention for caregivers.

Methods: Pilot factorial trial using the multiphase optimization strategy (October 2019-October 2020). Family caregivers and their care recipients with newly-diagnosed advanced cancer (n = 46 dyads) were randomized to1 of 8 experimental conditions that included a combination of one of the following three CASCADE components: 1) effective decision support psychoeducation; 2) decision support communication training; and 3) Ottawa Decision Guide training. Feasibility was assessed by completion of sessions and questionnaires (predefined as ≥80%). Acceptability was determined through postintervention interviews and participants' ratings of their likelihood to recommend. Measures of effective decision support and caregiver and patient distress were collected at Twelve and Twenty four weeks.

Results: Caregiver participants completed 78% of intervention sessions and 81% of questionnaires; patients completed 80% of questionnaires. Across conditions, average caregiver ratings for recommending the program to others was 9.9 on a scale from 1-Not at all likely to 10-Extremely likely. Individual CASCADE components were observed to have potential benefit for effective decision support and caregiver distress.

Conclusion: We successfully piloted a factorial trial design to examine components of a novel intervention to enhance the decision support skills of advanced cancer family caregivers. A fully-powered factorial trial is warranted.

Key message: We pilot tested components of CASCADE, an early palliative care decision support training intervention for family caregivers of patients with advanced cancer. CASCADE components were acceptable and the trial design feasible, providing promising future directions for palliative care intervention development and testing. Pilot results will inform a fully-powered trial.

Keywords: Palliative care; cancer; family caregiving; multiphase optimization strategy.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Caregivers
Humans
Mentoring*
Neoplasms* / therapy
Palliative Care / methods
Pilot Projects
Telemedicine*

Abstract

Publication types

MeSH terms

Grants and funding