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Cited by 85Grief, Bereavement, and Mental HealthPalliative Care and End-of-Life IssuesPalliative and Oncologic Care

Family Caregiver Depressive Symptom and Grief Outcomes From the ENABLE III Randomized Controlled Trial

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Dionne-Odom, J. Nicholas, Azuero, Andres, Lyons, Kathleen D., Hull, Jay G., Prescott, Anna T., Tosteson, Tor, Frost, Jennifer, Dragnev, Konstantin H. +1 more·2016·Journal of Pain and Symptom Management
DOI 10.1016/j.jpainsymman.2016.03.014PMC PMC5023481
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Abstract

Context Little is known about whether early palliative care (EPC) support for family caregivers (CGs) impacts depressive symptoms and grief after care recipients die. Objectives To assess after-death CG depressive symptom and grief scores for early compared to delayed group CGs. Methods We conducted a randomized controlled trial (10/2010-9/2013) of an EPC telehealth intervention for CGs (n = 123) initiated at the time of care recipients' advanced cancer diagnosis (early group) or 12 weeks later (delayed group) in a rural comprehensive cancer center, affiliated clinics, and a Veterans Administration medical center. The ENABLE [Educate, Nurture, Advise, Before Life Ends] CG intervention consisted of three weekly sessions, monthly follow-up, and a bereavement call. CGs completed the Center for Epidemiological Study-Depression (CES-D) scale and the Prigerson Inventory of Complicated Grief-Short Form (PG13) 8-12 weeks after care recipients' deaths. Crude and covariate-adjusted between-group differences were estimated and tested using general linear models. Results For care recipients who died (n = 70), 44 CGs (early: n = 19; delayed: n = 25) completed after-death questionnaires. Mean depressive symptom scores (CES-D) for the early group was 14.6 (SD = 10.7) and for the delayed group was 17.6 (SD = 11.8). Mean complicated grief scores (PG13) for the early group was 22.7 (SD = 4.9) and for the delayed group was 24.9 (SD = 6.9). Adjusted between-group differences were not statistically significant (CES-D: d = 0.07, P = 0.88; PG13: d = -0.21, P = 0.51). Conclusion CGs' depressive symptom and complicated grief scores 8-12 weeks after care recipients' deaths were not statistically different based on the timing of EPC support. The impact of timing of CG EPC interventions on CGs bereavement outcomes requires further investigation.

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  • 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.”

    From Palliative Care Coaching for Family Caregivers of Patients With Advanced Cancer (2026) · cites this paper as [14]

    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)

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Research works printed but not linked: 28

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Authors
Dionne-Odom, J. N., Azuero, A., Lyons, K. D., Hull, J. G., Prescott, A. T., Tosteson, T., Frost, J., Dragnev, K. H., & Bakitas, M. A.
Affiliations
  • University of Alabama at Birmingham (US)
  • Dartmouth College (US)
  • Dartmouth Cancer Center (US)
Corresponding author
Bakitas, Marie A.
ORCID
Venue
Journal of Pain and Symptom Management
Publisher
Elsevier BV
Published
2016-09
Volume
52
Issue
3
Pages
378-385
ISSN
0885-3924 (ISSN-L)
DOI
10.1016/j.jpainsymman.2016.03.014
PMC
PMC5023481
OpenAlex
W2414998575
Cited by
85
References
6
Citations by year
2026: 10 · 2025: 4 · 2024: 7 · 2023: 8 · 2022: 13 · 2021: 15 · 2020: 6 · 2019: 11 · 2018: 4 · 2017: 7
FWCI
9.82
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Pain and Symptom Management (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Nursing Research (R01NR011871-01)
  • Foundation for Informed Medical Decision-Making
  • Norris Cotton Cancer Center
  • Dartmouth-Hitchcock
  • American Cancer Society (MRSG 12-113-01–CPPB)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • 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
Keywords
family caregivers, early palliative care, caregiver depression, complicated grief, bereavement, advanced cancer, telehealth intervention, intervention timing, caregiver support, cancer mortality
MeSH terms
Depression, Family, Female, Follow-Up Studies, Grief, Humans, Male, Middle Aged, Palliative Care, Psychiatric Status Rating Scales, Time Factors, Single-Blind Method, Caregivers, Telemedicine

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