Licensed from AdobeStock: 448572757
Pain and symptom management for clients and support and resources for caregivers are important components of home hospice care. While home hospice is effective in reducing patient symptom burden, caregivers caring for an individual at end-of-life in the home are often challenged with evaluating and managing fluctuating symptoms and deciding when to call the hospice palliative care team for support.
Technology-assisted mobile health (mhealth) interventions have shown promise as compliments to hospice care provided in the home. This randomized control trial by Mooney and colleagues (2023) tested an automated mhealth system to determine if it was effective in reducing patient symptom burden while maintaining caregiver well-being.
Hospice patients with a cancer diagnosis and their caregivers were recruited from 12 hospices across four states in the United States and randomly assigned to either the “intervention” or “standard care” groups.
Caregivers in both the intervention and standard care groups received regular home hospice care according to the hospice’s policies. They also placed daily phone calls to the automated mhealth system, where the caregiver entered their assessment of the severity of 11 patient symptoms over the prior 24 hours.
Additionally, caregivers in the intervention group received immediate, automated patient care management messages based on the assessment of symptoms. These messages were developed based on national, evidence-based guidelines for end-of-life symptom management. Additionally, a notification was sent to the hospice when symptoms exceeded pre-set threshold severity values. A hospice nurse could then view the notification and decide how to respond. The nurse documented their decision in one of three categories:
- Monitor with no action
- Call the family
- Visit the family
A total of 298 patient/caregivers dyads completed the clinical trial. The results included a 38% reduction in moderate-to-severe symptom days for patients receiving the intervention, with both physical and psychosocial symptoms significantly reduced. Patients in the intervention group had lower total symptom severity and had a reported asymptomatic day on overage two-weeks earlier compared to patients in the standard care group. Patients in the intervention group had greater symptom reduction in 10 of the 11 monitored symptoms compared to the standard care group. There was no different between the two group in nausea and vomiting.
The results suggest that caregivers will utilize mhealth interventions. Such interventions can improve both overall and individual symptom burden at end-of-life as reported by caregivers. This study suggests that mhealth systems may be a beneficial complement to at-home hospice care.
Source: Mooney, K., Whisenant, M. S., Wilson, C. M., Coombs, L. A., Lloyd, J., Alekhina, N., … & Donaldson, G. (2023). Technology-Assisted mHealth Caregiver Support to Manage Cancer Patient Symptoms: A randomized controlled trial. Journal of Pain and Symptom Management.
