Improving the Mental Health of Home Hospice Caregivers through a Single Session Intervention
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Project Summary Approximately 2.3 million family caregivers (CGs) of patients at the end of life (EoL) experience significant mental health symptoms. Despite supportive services from hospice, 33% of hospice CGs experience moderate-to-severe anxiety, and 23% of hospice CGs experience moderate-to-severe depression. This contrasts with a 6% prevalence rate nationally for anxiety or depression in the general population. Family CGs of patients receiving home hospice care (hospice CGs) play a crucial role in daily caregiving duties, providing on average 12.6 hours of caregiving per day. However, this responsibility is also associated with poorer mental health outcomes for the CGs. Therefore, there is an urgent need to test feasible and acceptable methods to provide mental health care to CGs of home hospice patients to improve their health and well-being, while also enabling them to better support the individuals they care for. The overall objective of this proposal is to adapt and test the feasibility and acceptability of a single session intervention (SSI) aimed at improving the mental health of home hospice CGs in a pilot randomized controlled trial (RCT) with a 1:1 (SSI vs. usual care) allocation. The central hypothesis of our proposal is that implementing a SSI will be feasible and acceptable in home hospice CGs and will show preliminary efficacy in improving CG mental health outcomes. For Aim 1, we will adapt an SSI for hospice CGs using feedback from hospice/mental health providers and SSI experts. We will employ a modified Delphi approach to gather feedback to refine our SSI intervention until expert approval is achieved. Adjudication will result in an SSI protocol and manual, with components of mindfulness and solution-focused therapy, which will be pilot tested in Aim 2. For Aim 2, we will determine the feasibility and acceptability of implementing an SSI for home hospice CGs. Home hospice CGs (N = 60) will be randomized to SSI or usual care. Feasibility and acceptability measures will be based on Proctor's taxonomy of implementation outcomes. Preliminary effects on anxiety, depressive symptoms, and CG stress will be explored. Our proposal is expected to have a significant and positive impact by establishing the feasibility and acceptability of an SSI to improve the mental health of home hospice CGs who are often overburdened and overwhelmed. The development of CG-focused interventions in home hospice is critical in supporting family CGs and is a central tenet of high-quality palliative and hospice care.
