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Cited by 0Palliative Care and End-of-Life IssuesPalliative and Oncologic CareNursing care and research

Palliative Care Coaching for Family Caregivers of Patients With Advanced Cancer

Open access
Odom, J. Nicholas, Azuero, Andres, Taylor, Richard A., Young Pierce, Jennifer, McGowen, Chelsea L., Pisu, Maria, Rocque, Gabrielle, Reed, Rhiannon D. +7 more·2026·JAMA Network Open
DOI 10.1001/jamanetworkopen.2026.19807PMC PMC13291851
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Abstract

Importance: African American and rural-dwelling family caregivers of persons with newly diagnosed advanced cancer perform critical, time-intensive tasks and historically have had limited resources to support their role. Objective: To determine the effect of a lay coach–led, early palliative care telehealth intervention (Educate, Nurture, Advise, Before Life Ends [ENABLE] Cornerstone) for African American and rural-dwelling family caregivers of patients with advanced cancer on caregiver and patient outcomes at 24 weeks. Design, Setting, and Participants: This single-blind randomized clinical trial was conducted from January 2020 to May 2025 at outpatient oncology clinics at 2 large cancer centers in the Southeastern US. Participants were African American and rural-dwelling family caregivers aged 21 years or older self-identifying as an unpaid close friend or family member who is involved with the day-to-day medical care of a patient with advanced cancer. Intervention: The intervention included 6 weekly, 20- to 60-minute psychosocial telephonic sessions facilitated by a trained lay coach plus monthly follow-up. Usual care consisted of mailed pamphlets outlining resources for families at each of the cancer centers. Main Outcomes and Measures: The primary outcome was caregiver distress (anxiety and depressive symptoms as measured by the Hospital Anxiety and Depression Scale [HADS]) at 24 weeks. Secondary outcomes were caregiver and patient quality of life (QOL; measured with the Patient-Reported Outcomes Measurement Information System Global Health Short Form), caregiver burden (Montgomery-Borgatta Caregiver Burden Scale), and patient distress (HADS). Outcomes were assessed using baseline-constrained linear mixed-effects models. Results: A total of 222 family caregivers (mean [SD] age, 55.5 [14.7] years; 169 [76.1%] female; 114 [51.4%] African American; 101 White [45.5%]; 7 other race [3.2%]) and 165 patients (mean [SD] age, 60.7 [12.2] years; 98 [59.4%] female; 79 African American [47.9%]; 84 White [50.9%]; 2 other race [1.2%]) were randomized. At week 24, no relevant between-group differences were observed in caregiver HADS anxiety (mean [SE] baseline-adjusted difference, 0.23 [0.44]; Cohen d = 0.05; 95% CI, −0.14 to 0.24; P = .60) or HADS depressive symptom scores (mean [SE] baseline-adjusted difference, 0.04 [0.41]; Cohen d = 0.01; 95% CI, −0.19 to 0.21; P = .91). For all other outcomes, 24-week differences were of small magnitude and not statistically significant. Exploratory sensitivity analyses of caregivers distressed at baseline indicated improvements in caregiver anxiety (mean [SE] baseline-adjusted difference, −1.21 [0.53]; Cohen d = −0.38; 95% CI, −0.70 to −0.05) and patient mental health QOL (mean [SE] baseline-adjusted difference, 3.00 [1.37]; Cohen d = 0.45; 95% CI, 0.04 to 0.86), but no statistically significant differences in caregiver burden (mean [SE] baseline-adjusted difference, −1.15 [0.69]; Cohen d = −0.32; 95% CI, −0.71 to 0.06) and patient depression (mean [SE] baseline-adjusted difference, −1.30 [0.71]; Cohen d = −0.37; 95% CI, −0.77 to 0.03). Conclusions: This randomized clinical trial of a telehealth intervention for African American and rural-dwelling caregivers of patients with advanced cancer found no differences in caregiver and patient outcomes at 24 weeks. However, an exploratory sensitivity analysis indicated potential improvements in caregiver anxiety and patient mental health QOL. Trial Registration: ClinicalTrials.gov Identifier: NCT04318886

AI snapshot

Written from the paper’s full text.

TL;DR

In a 2-site, single-blind randomized clinical trial of 222 family caregivers of patients with newly diagnosed advanced cancer, a lay coach–led early palliative care telehealth intervention (ENABLE Cornerstone) did not improve caregiver distress at 24 weeks compared with usual care. Exploratory analyses suggested possible benefit among caregivers with elevated baseline distress.

Key findings

  • No between-group difference at 24 weeks in the primary outcome, caregiver HADS anxiety (baseline-adjusted difference, 0.23 [SE 0.44]; Cohen d = 0.05; 95% CI, −0.14 to 0.24; P = .60) or HADS depression (0.04 [0.41]; d = 0.01; 95% CI, −0.19 to 0.21; P = .92).
  • No statistically significant secondary caregiver or patient outcomes at 24 weeks; for example, caregiver PROMIS physical health d = 0.09 and mental health d = 0.00, and patient PROMIS mental health d = 0.25 (raw P = .06; adjusted P = .41).
  • In an exploratory sensitivity analysis of participants with baseline HADS subscale scores ≥8, the intervention group showed small-to-moderate differences at 24 weeks for caregiver anxiety (d = −0.38; 95% CI, −0.70 to −0.05), caregiver objective burden (d = −0.32; 95% CI, −0.71 to 0.06), patient depressive symptoms (d = −0.37; 95% CI, −0.77 to 0.03), and patient mental health QOL (d = 0.45; 95% CI, 0.04 to 0.86).
  • Intervention delivery: caregivers completed a mean of 4.5 sessions; 72 (63.7%) completed all 6 sessions; sessions lasted a mean of 35.6 minutes, and mean days to complete all 6 core sessions was 89.7.

Methods

  • 2-site, single-blind RCT conducted from January 2020 to May 2025 at the University of Alabama at Birmingham O’Neal Comprehensive Cancer Center and the University of South Alabama Mitchell Cancer Institute; 222 caregivers were randomized (113 intervention, 109 usual care), and 165 patients were enrolled (91 intervention, 74 usual care).
  • Eligible caregivers were unpaid spouses/partners, relatives, or friends providing regular support to patients with newly diagnosed advanced cancer and were either rural-dwelling or African American/Black; patients had stage III or IV cancer diagnosed within the past 60 days, were not receiving hospice, and had no active severe untreated mental illness, dementia, or uncorrected hearing loss.
  • The ENABLE Cornerstone intervention used trained lay coaches to deliver 6 weekly 20- to 60-minute telephone sessions plus monthly follow-up, guided by a family toolkit and caregiver distress thermometer; usual care received mailed resource pamphlets. Analysis was intention-to-treat using baseline-constrained linear mixed-effects models with all available data, Cohen d effect sizes, and false discovery rate correction for 24-week primary and secondary contrasts.

Limitations

  • The paper states that generalizability may be limited by recruitment from 2 Southeastern academic cancer centers with relatively robust supportive care resources and by a sample restricted to African American and rural-dwelling caregivers; 36.3% of intervention caregivers did not complete all 6 sessions; funding reductions lowered statistical power below the originally proposed target of 294 caregivers; the COVID-19 pandemic may have affected outcomes; and many caregivers and patients declined participation, raising acceptability and feasibility concerns.
  • The paper also states that low baseline distress (mean HADS anxiety 7.94; depression 5.31; ≥8 indicating high distress) may have created floor effects, and that the 24-week primary endpoint may have missed early (<3 months) or later (6–12 months) intervention benefits.
  • Evident from the text: patient enrollment was imbalanced between groups (91 intervention vs 74 usual care), though baseline patient characteristics were reported as balanced; intervention completion often extended beyond the intended 6 weekly sessions, which the authors note may have attenuated observed effects.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jamanetworkopen.2026.19807

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

20 of 26 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    African American and rural-dwelling family caregivers of patients with newly diagnosed advanced cancer face circumstances that can exacerbate challenges of the role.

    “African American and rural-dwelling family caregivers of patients with newly diagnosed advanced cancer not only shoulder a demanding set of caregiving responsibilities but also face circumstances that can exacerbate challenges of the role.1,2”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [1] National Alliance for Caregiving. Caregiving in a diverse America: beginning to understand the systemic challenges facing family caregivers. Published November 2021. Accessed May 13, 2026. https://www.caregiving.org/wp-content/uploads/2021/11/NAC_AmgenDiverseCaregiversReport_FinalDigital-111821.pdf source

      The Introduction describes demanding cancer-caregiving responsibilities, and Session 1, “Burden of Informal Cancer Caregiving” (page not provided), reports greater emotional distress among caregivers of people with advanced-stage disease. The paper does not establish that African American or rural-dwelling caregivers of newly diagnosed patients face additional circumstances that exacerbate those challenges. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [2] Kent EE, Rowland JH, Northouse L,. Caring for caregivers and patients: research and clinical priorities for informal cancer caregiving. Cancer. 2016; 122(13): 1987- 1995. doi: 10.1002/cncr.29939 26991807 PMC5597246 source

      The Discussion describes employment, finances, and childcare as collateral challenges for cancer caregivers, and the study’s participants were rural-dwelling. But the study does not establish that African American or rural-dwelling caregivers face distinct circumstances that exacerbate those challenges. The Findings report that caregivers were mostly white and had provided care for more than two years, rather than studying caregivers specifically at a new diagnosis. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Study design and conductreasoning

    The sample size provided 80% power to detect a small to moderate intervention effect of Cohen d = 0.38.

    “Assuming 38% attrition (based on our prior trials),14,17 an α of .05, and intrasubject correlation among 3 repeated measures of 0.5, the sample size provided 80% power to detect a small to moderate intervention effect of Cohen d = 0.38.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [14] Dionne-Odom JN, Azuero A, Taylor RA,. A lay navigator-led, early palliative care intervention for African American and rural family caregivers of individuals with advanced cancer (Project Cornerstone): results of a pilot randomized trial. Cancer. 2022; 128(6): 1321- 1330. doi: 10.1002/cncr.34044 34874061 PMC8882155 source

      The Methods > Statistical Analysis passage discusses observed effect sizes and says the small sample limited the analysis, but gives no prospective power calculation. A search for 80% power, Cohen’s d = 0.38, and the stated sample-size assumptions found no passage supporting the claimed detection threshold. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [17] Dionne-Odom JN, Azuero A, Lyons KD,. Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: outcomes from the ENABLE III randomized controlled trial. J Clin Oncol. 2015; 33(13): 1446- 1452. doi: 10.1200/JCO.2014.58.7824 25800762 PMC4404423 source
  • Premisecitation

    African American and rural caregivers have historically had limited access to formal resources and supportive services.

    “In addition, African American and rural caregivers have historically had limited access to formal resources and supportive services.”
    Quote in the paperSubstantial claim5 of 5 sources checked
    • cites [6] Kent EE, Lee S, Asad S, Dobbins EE, Aimone EV, Park EM. “If I wasn’t in a rural area, I would definitely have more support”: social needs identified by rural cancer caregivers and hospital staff. J Psychosoc Oncol. 2023; 41(4): 393- 410. doi: 10.1080/07347332.2022.2129547 36214743 PMC10083183 source

      The Discussion (page not provided) reports that rural caregivers have less social support and fewer workplace benefits, including employee assistance programs. This supports the rural-caregiver portion, but the paper does not establish a historical pattern of limited access to formal services or make that claim about African American caregivers. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [7] Xu H, Kadambi S, Mohile SG,. Caregiving burden of informal caregivers of older adults with advanced cancer: the effects of rurality and education. J Geriatr Oncol. 2021; 12(7): 1015- 1021. doi: 10.1016/j.jgo.2021.04.002 33858803 PMC8429077 source

      The Discussion (Clinical implications; page unavailable) describes historical discrimination against Black patients and families and recommends prioritizing Black families for supportive services. It does not establish that Black caregivers historically had limited access to formal resources or services, and the retrieved passages do not address rural caregivers. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [8] Fenton ATHR, Ornstein KA, Dilworth-Anderson P,. Racial and ethnic disparities in cancer caregiver burden and potential sociocultural mediators. Support Care Cancer. 2022; 30(11): 9625- 9633. 36190556 PMC9633462 source

      The Discussion (page unavailable) reports that non-metropolitan and non-Hispanic Black households had less digital access needed for telemedicine. This supports a narrower point about a barrier to health services, but the paper does not study caregivers or establish historical limits on their access to formal resources and supportive services. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [9] Curtis ME, Clingan SE, Guo H, Zhu Y, Mooney LJ, Hser YI. Disparities in digital access among American rural and urban households and implications for telemedicine-based services. J Rural Health. 2022; 38(3): 512- 518. doi: 10.1111/jrh.12614 34355427 PMC9827725 source

      The Background says socioeconomically disadvantaged families face transportation costs and less available family support, while the Discussion says intervention studies have largely focused on white caregivers. Neither passage establishes that African American or rural caregivers have historically had limited access to formal resources or supportive services. Searches for those groups and service access found no passage addressing that claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [10] Center to Advance Palliative Care. America’s readiness to meet the needs of people with serious illness: 2024 serious illness scorecard. Published 2024. Accessed May 13, 2026. https://scorecard.capc.org/ source
  • Premisecitation

    Barriers such as geographic isolation, socioeconomic disadvantage, limited broadband access, and systemic inequities in access to palliative and psychosocial care can contribute to unmet needs for information, skills training, and emotional support.

    “Barriers such as geographic isolation, socioeconomic disadvantage, limited broadband access, and systemic inequities in access to palliative and psychosocial care can contribute to unmet needs for information, skills training, and emotional support.6,7,8,9,10”
    Quote in the paperSubstantial claim5 of 5 sources checked
    • cites [6] Kent EE, Lee S, Asad S, Dobbins EE, Aimone EV, Park EM. “If I wasn’t in a rural area, I would definitely have more support”: social needs identified by rural cancer caregivers and hospital staff. J Psychosoc Oncol. 2023; 41(4): 393- 410. doi: 10.1080/07347332.2022.2129547 36214743 PMC10083183 source

      The Discussion (page not specified) links rural caregivers’ geographic isolation and lower education to lack of social support, and calls for caregiving training and psychosocial interventions. The Results (page not specified) also report greater lack of social support among rural caregivers, particularly those with less education. The paper does not establish limited broadband access, systemic inequities in access to palliative or psychosocial care, or unmet information needs as contributors. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [7] Xu H, Kadambi S, Mohile SG,. Caregiving burden of informal caregivers of older adults with advanced cancer: the effects of rurality and education. J Geriatr Oncol. 2021; 12(7): 1015- 1021. doi: 10.1016/j.jgo.2021.04.002 33858803 PMC8429077 source

      The Background discusses economic discrimination and systemic racism, and the Methods identifies emotional support and caregiving preparedness as relevant resources. But the paper does not link those barriers to unmet information or skills-training needs, or address geographic isolation, broadband access, or inequitable access to palliative and psychosocial care (searched for those terms and related unmet needs). (LLM, conf=0.80)

      Experimental — accuracy not yet measured
    • cites [8] Fenton ATHR, Ornstein KA, Dilworth-Anderson P,. Racial and ethnic disparities in cancer caregiver burden and potential sociocultural mediators. Support Care Cancer. 2022; 30(11): 9625- 9633. 36190556 PMC9633462 source

      The Discussion and Conclusion (page not provided) link rural residence, low income, and limited digital access to reduced access to telemedicine-based health care. They do not address inequities in palliative or psychosocial care, or unmet needs for information, skills training, and emotional support. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [9] Curtis ME, Clingan SE, Guo H, Zhu Y, Mooney LJ, Hser YI. Disparities in digital access among American rural and urban households and implications for telemedicine-based services. J Rural Health. 2022; 38(3): 512- 518. doi: 10.1111/jrh.12614 34355427 PMC9827725 source

      The Background (page unavailable) identifies distance caregivers and says socioeconomic disadvantage brings transportation costs and other caregiving challenges. The Discussion (page unavailable) describes caregivers’ needs for skills and informational interventions and resources for emotional support. Our copy does not link those needs to limited broadband or systemic inequities in access to palliative and psychosocial care, and it does not establish the full causal chain claimed. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [10] Center to Advance Palliative Care. America’s readiness to meet the needs of people with serious illness: 2024 serious illness scorecard. Published 2024. Accessed May 13, 2026. https://scorecard.capc.org/ source

      The Background (page not available) says African American and rural-dwelling advanced-cancer family caregivers are often under-resourced, have poor access to formal support services, and receive no formal training. This supports the broad point about unmet support and training needs, but our copy does not identify limited broadband access or specifically establish the claimed links from socioeconomic disadvantage and systemic inequities in palliative and psychosocial care to those needs. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    There has been a lack of culturally responsive interventions for historically underresourced groups of family caregivers of patients with advanced cancer, namely African American and rural-dwelling individuals.

    “There has been a lack of culturally responsive interventions for historically underresourced groups of family caregivers of patients with advanced cancer, namely African American and rural-dwelling individuals.2,11”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [2] Kent EE, Rowland JH, Northouse L,. Caring for caregivers and patients: research and clinical priorities for informal cancer caregiving. Cancer. 2016; 122(13): 1987- 1995. doi: 10.1002/cncr.29939 26991807 PMC5597246 source

      The Discussion (page unavailable) says there is a lack of effective interventions to support families’ decision-partnering role in advanced cancer care. The Methods describe a study of rural-dwelling caregivers, but the paper does not establish a lack of culturally responsive interventions specifically for African American and rural-dwelling caregivers. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [11] Ferrell B, Wittenberg E. A review of family caregiving intervention trials in oncology. CA Cancer J Clin. 2017; 67(4): 318- 325. doi: 10.3322/caac.21396 28319263 source
  • Classified as probably not a substantial claim. 16
  • May combine two claims. 21

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The ENABLE Cornerstone intervention is based on the Pearlin Stress Process of Family Caregiving.

    “Details of the ENABLE Cornerstone intervention, based on the Pearlin Stress Process of Family Caregiving,23 have been described in detail in our previously published protocol.12”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [23] Pearlin LI, Mullan JT, Semple SJ, Skaff MM. Caregiving and the stress process: an overview of concepts and their measures. Gerontologist. 1990; 30(5): 583- 594. doi: 10.1093/geront/30.5.583 2276631 source

      The Introduction discusses cancer caregiver interventions generally, but does not mention ENABLE Cornerstone or the Pearlin Stress Process. A search for those terms and for the intervention’s theoretical framework found no passage in our copy addressing the claimed basis of ENABLE Cornerstone. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The study protocol has been previously published and is available on ClinicalTrials.gov.

    “The study protocol has been previously published12 and is available on ClinicalTrials.gov.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Bechthold AC, Azuero A, Pisu M,. The Project ENABLE Cornerstone randomized controlled trial: study protocol for a lay navigator-led, early palliative care coaching intervention for African American and rural-dwelling advanced cancer family caregivers. Trials. 2022; 23(1): 452. doi: 10.1186/s13063-022-06305-w 35655285 PMC9161197 source

  • May combine two claims.

    Premisecitation

    The minimally distressed sample contrasts with other caregiving trials that had better outcomes with a more distressed sample; for example, the Forst et al. trial had mean baseline HADS anxiety scores above 11 and used GAD-7 ≥5 as eligibility.

    “Our minimally distressed sample contrasts with other caregiving trials that had better outcomes with a more distressed sample; for example, a recent trial by Forst and colleagues35 of an effective behavioral health specialist–led telehealth intervention for caregivers of patients with primary malignant brain tumors consisted of a sample where the mean baseline HADS anxiety scores in both groups”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [35] Forst DA, Podgurski AF, Strander SM,. NeuroCARE: a randomized controlled trial of a psychological intervention for caregivers of patients with primary malignant brain tumors. J Clin Oncol. 2024; 42(36): 4252- 4262. doi: 10.1200/JCO.24.00065 39284103 source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Our lower enrollment rate is consistent with other cancer caregiving trials, reflecting the challenge of recruiting cancer caregivers during a period of high emotional and logistical demands.

    “Our lower enrollment rate is consistent with other cancer caregiving trials,46 reflecting the challenge of recruiting cancer caregivers during a period of high emotional and logistical demands.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [46] Song L, Qan’ir Y, Guan T,. The challenges of enrollment and retention: a systematic review of psychosocial behavioral interventions for patients with cancer and their family caregivers. J Pain Symptom Manage. 2021; 62(3): e279- e304. doi: 10.1016/j.jpainsymman.2021.04.019 33933618 PMC8419067 source

  • May combine two claims.

    Findingown data

    ENABLE Cornerstone did not demonstrate statistically significant differences in the primary outcome (caregiver distress at 24 weeks) or secondary caregiver and patient outcomes.

    “The results showed that ENABLE Cornerstone, a lay coach–led, early palliative care telehealth intervention, did not demonstrate statistically significant differences in the primary outcome, caregiver distress at the 24-week time point, or secondary caregiver and patient outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    At baseline, mean HADS anxiety was 7.94 and depression was 5.31.

    “At baseline, mean (SD) HADS scores were 7.94 (0.29) for anxiety and 5.31 (0.26) for depression.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Data collectors and processors, the principal investigator, the study biostatistician, and coinvestigators were blinded.

    “Data collectors and processors, the principal investigator, the study biostatistician, and coinvestigators were blinded.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The trial was a 2-site, single-blind randomized clinical trial.

    “This was a 2-site, single-blind RCT.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Follow-up data at 24 weeks were available for 169 caregivers and 127 patients, with missed surveys primarily due to patient death (33 patients).

    “Follow-up data at 24 weeks were available for 169 caregivers and 127 patients, with missed surveys primarily due to patient death (33 patients) (Figure).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Caregivers were randomly assigned 1:1 to intervention or usual care using a computer-generated, concealed randomization scheme.

    “Following consent and completion of baseline questionnaires, caregivers were randomly assigned 1:1 to intervention or usual care by the project manager (S.E.) using a computer-generated, concealed randomization scheme.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Analyses were conducted following an intention-to-treat principle.

    “We conducted all analyses following an intention-to-treat principle.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    All sessions were audio-recorded, and 25% were randomly selected at quarterly intervals for treatment fidelity using a structured checklist.

    “All sessions were audio-recorded, and 25% were randomly selected at quarterly intervals for treatment fidelity using a structured checklist.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    In the intervention group, caregivers completed a mean of 4.5 sessions, with 72 (63.7%) completing all 6 sessions and 41 (36.3%) completing fewer than 6 sessions.

    “In the intervention group, caregivers completed a mean of 4.5 sessions, with 72 (63.7%) completing all 6 sessions and 41 (36.3%) completing fewer than 6 sessions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Coaches underwent structured training of approximately 70 hours and ongoing weekly supervision by board-certified palliative care clinicians.

    “Coaches underwent structured training that was approximately 70 hours in length, including focused content on lay navigation, health coaching, palliative care in oncology, and family caregiving. Ongoing weekly supervision was provided by board-certified palliative care clinicians to review participant cases and ensure adherence to the study protocol across both sites.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The research was approved by WIRB Copernicus Group and local IRBs; all participants provided written informed consent.

    “The research was approved by the WIRB Copernicus Group (formerly Western IRB) and the local institutional review boards of the 2 enrolling sites (the University of Alabama at Birmingham and the University of South Alabama). All participants provided written informed consent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Participants and interventionists were not blinded due to the behavioral nature of the intervention.

    “Participants and interventionists were not blinded due to the behavioral nature of the intervention.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Randomization was stratified by site and blocked within strata using random block lengths of 6.

    “The randomization scheme was stratified by site (University of Alabama at Birmingham and Mitchell Cancer Institute) and blocked within strata (using random block lengths of 6).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The CONSORT reporting guideline was adhered to for trial conduct and reporting.

    “The Consolidated Standards of Reporting Trials (CONSORT) reporting guideline22 was adhered to for trial conduct and reporting.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Montgomery P, Grant S, Mayo-Wilson E,; CONSORT-SPI Group. Reporting randomised trials of social and psychological interventions: the CONSORT-SPI 2018 extension. Trials. 2018; 19(1): 407. doi: 10.1186/s13063-018-2733-1 30060754 PMC6066921 source

  • May combine two claims.

    Study design and conductreasoning

    Although the intervention was designed as 6 weekly sessions, completion often extended over a longer period, reflecting the need to accommodate caregiver schedules and competing demands.

    “Relatedly, although the intervention was designed as 6 weekly sessions, completion often extended over a longer period, reflecting the need to accommodate caregiver schedules and competing demands.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Not receiving the full dose of the intervention may have resulted in those caregivers acquiring fewer skills to effectively counter distress and support their care recipients.

    “Not receiving the full dose of the intervention may have resulted in those caregivers acquiring fewer skills to effectively counter distress and support their care recipients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study period overlapped with the COVID-19 pandemic, which may have influenced caregiver burden, distress, and access to supportive care services.

    “Fourth, the study period overlapped with the COVID-19 pandemic, which may have influenced caregiver burden, distress, and access to supportive care services.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Screening for more distressed individuals could identify those more likely to benefit from support, obviate floor effects, and make more efficient use of resources.

    “Namely, screening for more distressed individuals could identify those more likely to benefit from support, which would also obviate any potential floor effects, where there is little room for improving outcomes, and make more efficient use of financial and human resources.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The Cornerstone intervention, including the lay coach training curriculum and the Toolkit, were fully manualized to enhance fidelity and to make large-scale replication and dissemination feasible.

    “Second, the Cornerstone intervention, including the lay coach training curriculum and the Toolkit, were fully manualized to enhance fidelity and to make large-scale replication and dissemination feasible.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Although both groups were similarly exposed to these external conditions, pandemic-related factors may have affected study outcomes.

    “Although both groups were similarly exposed to these external conditions, pandemic-related factors may have affected study outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    These findings highlight the importance of distress screening to identify subgroups most likely to benefit, suggest that benefits may accrue outside of the 24-week assessment window, and demonstrate the feasibility of scalable, lay coach-led telehealth models for underresourced caregiving populations.

    “These findings highlight the importance of distress screening to identify subgroups most likely to benefit, suggest that benefits may accrue outside of the 24-week assessment window, and demonstrate the feasibility of scalable, lay coach–led telehealth models for underresourced caregiving populations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    There were a considerable number of caregivers and patients who declined participation, potentially raising concerns of acceptability and feasibility.

    “Fifth, there were a considerable number of caregivers and patients who declined participation, potentially raising concerns of acceptability and feasibility.”
    Quote in the paperNot a substantial claim
26 of 26

  • The authors state this as an assumption.

    Missing outcome data were missing at random.

    “Missing outcome data were handled using linear mixed-effects models under a missing-at-random assumption.”

  • The paper relies on this without support.

    This study is the largest RCT to date of advanced cancer caregiving and patient participants who identify as African American or rural dwelling.

    “First, to our knowledge, this is the largest RCT to date of advanced cancer caregiving and patient participants who identify as African American or rural dwelling.”

  • The paper relies on this without support.

    ENABLE Cornerstone is a culturally responsive intervention.

    “In this large, 2-site RCT evaluating a culturally responsive, lay coach–delivered early palliative care intervention for African American and rural-dwelling caregivers of patients with newly diagnosed advanced cancer”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • HADS subscale minimum differs between Methods and table notes

    Minor

    Methods states that HADS subscale scores start at 0, but the notes to Tables 3 and 4 state that they start at 1.

  • Caregiver objective-burden confidence interval differs from Table 3

    Minor

    The results text gives a 95% CI of −0.42 to 0.10 for objective burden, whereas Table 3 gives −0.29 to 0.23.

  • Baseline HADS values are labeled SD in the text but SE in Table 3

    Minor

    The text calls 0.29 and 0.26 standard deviations, while Table 3 labels its columns containing those same baseline values as standard errors.

  • Patient depression confidence interval loses its negative sign

    Minor

    The results text reports a lower confidence limit of 0.46, but Table 4 reports −0.46 for the same patient depression contrast.

  • Percentages for patients who declined enrollment use a different denominator

    Minor

    The text says 58 patients declined enrollment, but 38 of 58 is 65.5%, not 66.7%. The discrepancy appears for both the male and African American counts.

    Reported 66.7 · recomputed 65.517241

5 of 5

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Cohen, 1988, Statistical Power Analysis for the Behavioral Sciences

Authors
Odom, J. N., Azuero, A., Taylor, R. A., Young Pierce, J., McGowen, C. L., Pisu, M., Rocque, G., Reed, R. D., Wells, R., Gazaway, S., Mollman, S., Williams, G. R., Huang, C.-H. S., Engler, S., & Bakitas, M. A.
Affiliations
  • School of Nursing, University of Alabama at Birmingham
  • University of Alabama at Birmingham (US)
  • Mitchell Cancer Institute, University of South Alabama, Mobile
  • University of South Alabama (US)
  • NYU Langone Health (US)
  • South Dakota State University (US)
  • Lewis and Faye Manderson Cancer Center, Tuscaloosa, Alabama
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2026-06-23
Volume
9
Issue
6
Pages
e2619807
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2026.19807
PMC
PMC13291851
OpenAlex
W7165691091
Semantic Scholar
831e771d60ec2d1e7342954ae9e5a6003f5e63ba
Cited by
0
References
38
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • JAMA Network Open (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
Keywords
family caregivers, advanced cancer, African American caregivers, rural caregivers, telehealth intervention, caregiver distress, caregiver burden, quality of life, patient distress, psychosocial support, early palliative care, anxiety, depression, patient-reported outcomes, racial disparities in cancer care, rural health disparities
MeSH terms
Mentoring, Adult, Aged, Anxiety, Black or African American, Depression, Female, Humans, Male, Middle Aged, Neoplasms, Palliative Care, Quality of Life, Single-Blind Method, Caregivers

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-14.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-14.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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