Perceived Benefits and Burdens of Participation for Caregivers of Cancer Patients in Hospice Clinical Trials: A Pilot Study

• Published in: Journal of pain and symptom management Vol. 61; no. 6; pp. 1147 - 1154
• Main Authors: Oliver, Debra Parker, Benson, Jacquelyn J., Ulrich, Connie, Washington, Karla T., Rolbiecki, Abigail J., White, Patrick, Smith, Jamie B., Lero, Christina, Landon, Olivia J., Demiris, George
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2021; Elsevier Limited
• Subjects: Adult children; Anxiety; Cancer; Caregiver burden; Caregivers; Caregiving; Clinical research; clinical trial; Clinical trials; Consent; Demography; Hospice; Hospice Care; Hospices; Humans; Informed consent; Intervention; Life expectancy; Mental depression; Mental health; Middle Aged; Neoplasms - therapy; participation; Perceptions; Pilot Projects; Quality of Life; Recruitment; Technology; clinical trial; participation; caregivers; Hospice; recruitment; research
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2020.10.024

Hospice is a service for those with a life expectancy of six months or less. Family caregivers suffer from depression and anxiety as they care for their loved one until they die. Little is known about how research participants decide to consent to participate in clinical trials in the hospice setting.
This pilot study sought to answer two research questions: 1) In what way do demographic characteristics, mental health, and perceived caregiving experience impact the decision by caregivers to participate in hospice clinical trials? 2) In what ways do the perceived physical, psychological, economic, familial, and social dimensions of caregivers' lives influence their decision to participate in hospice clinical trials?
The characteristics and stated reasons for consent of hospice caregivers participating in a clinical trial were compared with individuals who refused clinical trial consent and only consented to this pilot study. Demographic, mental health, and perceptions of caregiving experience were measured as influencers to the consent decision. Recruitment calls were recorded and coded using framework analysis to identify perceived benefits and burdens impacting the decision to consent to the clinical trial.
Overall, trial participants were more often adult children to the patient (55% vs. 21%, P = 0.005), younger (56 vs. 63 years, P = 0.04), and employed (47% vs. 24%, P = 0.02) as compared with those who did not consent to participate in the trial. Reported levels of depression, anxiety, and quality of life were not significantly different between those who chose to participate in the clinical trial and those who participated only in this pilot study; however, caregiver burden was higher for those consenting to the clinical trial (4.05 vs. 7.16, P < 0.0001). Perceived benefits expressed by both groups were largely psychological as participants felt positive about contributing to science. Burdens expressed by both groups were predominately physical as they related to hesitation to participate in the intervention because of technology or the burdens of caregiving.
The benefits and burdens model for clinical trial participation is applicable to the caregiver experience in the hospice setting. Understanding the perceptions and dimensions of benefits and burdens to potential study participants is critical to not only the intervention design but also the tailoring of recruitment contacts and informed consent process.