Background

While home-based hospice care seeks to reduce suffering at the end of life (EoL), patients continue to experience a high symptom burden. High symptom burden contributes to adverse outcomes, including patient suffering, burdensome care transitions, and caregiver burden. Yet, most caregivers lack formal education in patient symptom management despite providing up to 65 h of care per week. Interventions that provide symptom support and education to caregivers could improve EoL outcomes for patients and caregivers.

Methods

We conducted a pilot randomized controlled trial (N = 80) in a hospice organization to assess the feasibility, acceptability, and preliminary efficacy of the Improving Home Hospice Management of End-of-life Symptoms (I-HoME) intervention. This caregiver-focused intervention aims to reduce patient symptom burden through weekly tele-visits with a nurse practitioner and caregiver educational videos to provide symptom support and education.

Results

The mean age of caregivers (N = 80) was 60.3 (standard deviation ± 12.1); with a majority being women (79%) and children of the patient (67%). In the I-HoME group (n = 40), a total of 121 of a possible 145 tele-visits (83%) were completed. Over 96% of caregivers were either satisfied or very satisfied with the tele-visits. Eighty-three percent agreed or strongly agreed that it prepared them to manage symptoms better, while 88% agreed or strongly agreed that the intervention increased their confidence in managing symptoms. The average reduction in patient symptom burden, as measured by the Edmonton Symptom Assessment Scale, for the intervention group who received all six visits was 6.6 points compared to 2.9 for the control group.

Conclusions

The I-HoME intervention was feasible to implement in the home hospice setting and acceptable to caregivers and hospice staff. Future efficacy trials are needed to determine whether this caregiver-focused intervention, which provides symptom support and education, can measurably improve patient and caregiver outcomes in the home hospice setting.

Link to Full Article

Link to article: iHome Pilot Study