Dyadic psychological intervention for patients with cancer and caregivers in home-based specialized palliative care: The Domus model

Heymann, Annika von; Puggaard, Louise Berg; Nissen, Kathrine G.; Benthien, Kirstine Skov; Bidstrup, Pernille Envold; Coyne, James C.; Johansen, Christoffer; Kjellberg, Jakob; Nordly, Mie; Sjögren, Per; Timm, Helle Ussing; Maase, Hans von der; Guldin, Mai-Britt

doi:10.1017/s1478951517000141

Cited by 30 publications

(44 citation statements)

References 32 publications

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“…The psychologists participating in this study performed a manualized intervention specified at supporting patient and caregiver dyads in spending the most possible time at home. 22 Two sessions were offered to all, and the following sessions were based on needs. The intervention began with a home conference planned to take place within five working days.…”

Section: Intervention (I) and Usual Care (C)mentioning

confidence: 99%

Causes of Hospital Admissions in Domus: A Randomized Controlled Trial of Specialized Palliative Cancer Care at Home

Benthien

Nordly

Heymann

et al. 2018

Journal of Pain and Symptom Management

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Context. Avoidable hospital admissions are important negative indicators of quality of end-of-life care. Specialized palliative care (SPC) may support patients remaining at home. Objectives. Therefore, the purpose of this study was to investigate if SPC at home could prevent hospital admissions in patients with incurable cancer. Methods. These are secondary results of Domus: a randomized controlled trial of accelerated transition to SPC with psychological intervention at home (Clinicaltrials.gov: NCT01885637). Participants were patients with incurable cancer and limited antineoplastic treatment options and their caregivers. They were included from the Department of Oncology, Rigshospitalet, Denmark, between 2013 and 2016. The control group received usual care. Outcomes were hospital admissions, causes thereof, and patient and caregiver perceptions of place of care (home, hospital, etc.) at baseline, four weeks, eight weeks, and six months. Results. During the study, 340 patients were randomized and 322 were included in modified intention-to-treat analyses. Overall, there were no significant differences in hospital admissions between the groups. The intervention group had more admissions triggered by worsened general health (22% vs. 16%, P ¼ 0.0436) or unmanageable home situation (8% vs. 4%, P ¼ 0.0119). After diagnostics, admissions were more often caused by clinical symptoms of cancer without progression in the intervention group (11% vs. 7%, P ¼ 0.0493). The two groups did not differ significantly in overall potentially avoidable admissions. Both groups felt mostly safe about their place of care. Conclusion. The intervention did not prevent hospital admissions. Likely, any intervention effects were outweighed by increased identification of problems in the intervention group leading to hospital admissions. Overall, patients and caregivers felt safe in their current place of care.

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Section: Intervention (I) and Usual Care (C)mentioning

confidence: 99%

Causes of Hospital Admissions in Domus: A Randomized Controlled Trial of Specialized Palliative Cancer Care at Home

Benthien

Nordly

Heymann

et al. 2018

Journal of Pain and Symptom Management

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“…The Domus RCT investigated home‐based SPC with dyadic psychological support for patients with advanced cancer and their caregivers . Dyads were recruited at the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark.…”

Section: Methodsmentioning

confidence: 99%

“…We previously described the design of the Domus RCT and the psychological intervention component in detail . Briefly, the intervention consisted of accelerated, coordinated transition from hospital‐based oncological treatment to home‐based SPC, alongside care as usual .…”

Section: Methodsmentioning

confidence: 99%

“…We previously reported that the Domus intervention significantly reduced symptoms of anxiety and depression in caregivers . In developing the psychological intervention, we hypothesized that supporting dyadic coping would be one mechanism by which the intervention would decrease distress in dyads . We therefore also investigate whether effects on stress communication and common coping mediated effects on caregivers' symptoms of anxiety and depression in the same RCT.…”

Section: Introductionmentioning

confidence: 97%

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Dyadic coping in specialized palliative care intervention for patients with advanced cancer and their caregivers: Effects and mediation in a randomized controlled trial

et al. 2018

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Objective: Specialized palliative care (SPC) interventions increasingly include patient-caregiver dyads, but their effects on dyadic coping are unknown. We investigated whether an SPC and dyadic psychological intervention increased aspects of dyadic coping in patients with advanced cancer and their caregivers, whether dyad characteristics moderated effects and whether aspects of dyadic coping mediated significant intervention effects on caregivers' anxiety and depression. Methods:We randomized 258 patients with incurable cancer and their caregivers to care as usual or accelerated transition from oncological treatment to home-based SPC and dyadic psychological support. In secondary outcome analyses, using mixedeffects models, we estimated intervention effects and 95% confidence intervals (CIs) for communication of stress and common coping, and moderation by dyad type and demographics. In path analyses, we investigated whether stress communication and common coping mediated intervention effects on caregivers' symptoms of anxiety and depression. (Clinicaltrials.gov NCT01885637). Results:The intervention significantly increased common coping in patients and caregivers in couples (estimated difference, 0.68; 95% CI, 0.11 to 1.24) and stress communication by partner caregivers (0.97; 0.24 to 1.24). We found some support for different intervention effects for spouses and other dyads, but no evidence of mediation.Conclusions: Specialized palliative care and dyadic psychological intervention may affect aspects of dyadic coping. Common coping and stress communication did not mediate the previously found significant intervention effects on caregiver anxiety and depression, indicating that other mechanisms may have been central in the intervention.The stressful life with advanced cancer requires patients and caregivers to cope individually and together. 1,2 Multidisciplinary specialized palliative care (SPC) aims to relieve suffering in patients with life-threatening illness and their families 3 and can significantly improve quality of life of patients with advanced cancer. 4 According to the systemic transactional model of coping (STM), couples may cope with stressors such as cancer in individual and interactional ways. 2,5 Dyadic coping is a reciprocal process in which each partner's communication of stress serves to elicit support from the other partner, like helping with or taking over tasks (supportive/delegated coping), and common coping, ie, managing a problem together. 5 In patients with cancer, stress communication has been related to better dyadic adjustment 6 and quality of life. 7 Greater common coping efforts, such as joint problem-solving or relaxation, have been found to predict increased relationship quality and lower depressive symptoms in dyads coping with cancer 8 but have also been associated with lower distress in caregivers and increased distress in patients. 6 Psychological interventions targeting dyads of patients with advanced cancer and their partners or caregivers may significantly improve, eg, psy...

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“…Of the studies that have evaluated caregivers (mostly yoga or MBSR), many have utilized interventions tailored to patient-caregivers dyads. 35,[37][38][39][40] Although this approach has merit, it may limit speci cally addressing caregivers' psychological and physical needs. Additionally, while many MBSR and yoga studies show positive effects on mental health, most do not include physical function and disability measures.…”

Section: Mind-body Therapies For Caregivers--gaps In the Current Evidmentioning

confidence: 99%

Qigong Mind-Body Program for Caregivers of Cancer Patients: Design of a Pilot Three-Arm Randomized Clinical Trial

Budhrani-Shani

Raeesi

Walter

et al. 2020

Preprint

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Background: Informal caregivers, often family and friends, experience significant psychological and physical distress leading to reductions in health and quality of life (QOL). Mind-body interventions focused on caregivers are often limited and do not address multiple barriers, including caregivers’ economic, geographic, and time constraints. Translation of in-person, community-based interventions to internet-based delivery may offer greater accessibility for caregivers, leading to increased adherence.Methods: Caring for Caregivers with Mind-Body Exercise implements a three-arm, pilot, randomized controlled trial to evaluate the feasibility of delivering a Qigong intervention (Eight Brocades) to cancer caregivers. A total of 54 cancer caregivers will be randomized into one of three 12-week programs: (1) community-based Qigong; (2) internet-based Qigong; or (3) a self-care control group. Study specific aims include 1) Modify intervention content for online delivery; 2) Evaluate the feasibility of recruiting and retaining cancer caregivers into a 12-week clinical trial; and 3) Evaluate the feasibility of collecting and managing data, and the suitability of questionnaires for this population. Several outcomes will be assessed, including caregiver QOL, caregiver burden, caregiver distress, perceived social support, physical function, and cognitive function. A 6-month follow-up will also assess longer-term changes in QOL and psychosocial wellbeing.Discussion: Findings will be used to inform the design and conduct of a large-scale comparative effectiveness trial evaluating caregivers who received Qigong training delivered through community-based vs internet-based programs. A finding that either or both programs are effective would inform care and options for caregivers.Trial registration: NCT04019301; registered on July 15, 2019; clinicaltrials.gov.

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Dyadic psychological intervention for patients with cancer and caregivers in home-based specialized palliative care: The Domus model

Cited by 30 publications

References 32 publications

Causes of Hospital Admissions in Domus: A Randomized Controlled Trial of Specialized Palliative Cancer Care at Home

Causes of Hospital Admissions in Domus: A Randomized Controlled Trial of Specialized Palliative Cancer Care at Home

Dyadic coping in specialized palliative care intervention for patients with advanced cancer and their caregivers: Effects and mediation in a randomized controlled trial

Qigong Mind-Body Program for Caregivers of Cancer Patients: Design of a Pilot Three-Arm Randomized Clinical Trial

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