Caregiver Outlook: An Intervention to Improve Caregiving in Serious Illness

• Caregiver Anxiety [ Time Frame: change in anxiety 5, 7, 15 weeks post-baseline ] [ Designated as safety issue: No ]
  POMS anxiety sub-scale
  
  

• Spirituality [ Time Frame: 5 and 7 weeks post-baseline ] [ Designated as safety issue: No ]
  FACIT-SP subscale
  
  
• Depression [ Time Frame: 5 and 7 weeks post-baseline ] [ Designated as safety issue: No ]
  Centers for Epidemiologic Study of Depression short form (CESD)
  
  
• Anticipatory grief [ Time Frame: 5 and 7 weeks post-baseline ] [ Designated as safety issue: No ]
  Anticipatory Grief Scale
  
  
• Patient days at home [ Time Frame: 5 and 7 weeks post-baseline ] [ Designated as safety issue: No ]
  number of patient days at home
  
  
• Caregiver burden [ Time Frame: change in burden 5, 7 and 11 weeks post-baseline ] [ Designated as safety issue: No ]
  Caregiver Reaction Assessment (CRA)
  
  
• Caregiver completion and preparation [ Time Frame: change in preparation and completion 5, 7, 15 weeks post-baseline ] [ Designated as safety issue: No ]
  QUAL-E fam
  
  
• Prolonged Grief [ Time Frame: 5 and 7 weeks post-baseline ] [ Designated as safety issue: No ]
  PG-12 (Prolonged Grief 12 scale)
  
  

The investigators propose a randomized control trial to evaluate an intervention of end-of-life preparation and completion with veterans and their caregivers at end-of-life. Specific aims are to 1) Evaluate the impact of the caregiver Outlook intervention on caregiver anxiety, depression, anticipatory grief, completion, and burden; 2) Evaluate the impact of the home versus in hospital, emergency department, or nursing facility; 3) Evaluate the impact of the intervention session's qualitative content, examining variation associated with selected demographic variables, quality of family communication, and stage of illness on change.

Caregivers in the first group ("treatment") will meet with a facilitator three times for a period of forty-five minutes each. In the first session, subjects will be asked to discuss issues related to relationship life review. In session two, participants will be asked to speak in more depth about issues such as regret and forgiveness. In the final session, subjects will focus on legacy and celebration. Caregivers in the second group ("attention control") will meet with a facilitator three times for a period of forty-five minutes each and be asked to listen to a non-guided relaxation CD.

Participants in both groups will receive pre and post-test measures administered by a blinded interviewer. Outcome measures will be measures by the FACT-G, Quality of life scale, FACIT-sp sub-scale, Anticipatory Grief Scale, Caregiver Reaction Assessment, the Qual-E completion and preparation sub-scales, and patient days at home.