eHealth disease educational intervention vs. outpatient palliative care as usual among incurable cancer patients cared by family caregivers at home.

Abstract

12062 Background: To determine whether ehealth disease educational interventions (eDEI) with fast-delivering interfaces and concise key messages can enhance capability of family caregivers and improve physical and psychological aspects of health-related quality of life (HRQoL) of incurable cancer patients at home. Methods: A randomized, open-label controlled trial was conducted in cancer center in Shanghai, China. Eligible participants (age≥18 years) with incurable cancer receiving palliative care and Karnofsky performance ≤ 70, along with a family caregiver (age ≥18 years), were randomly assigned 1:1 to either intervention (eDEI plus palliative care as usual (CAU)) or control group (CAU only). eDEI as a mobile application provides family caregivers with texts, audios and videos of symptom/side effect management and nursing skills. The intervention lasted for two months.The primary outcomes were physical aspects of HRQoL on the European Organization for Research and Treatment of Cancer Core Quality of Life Scale (EORTC QLQ-C30) and psychological aspects of HRQoL on the Hamilton Anxiety Rating Scale (HAM-A) from baseline to the end of 2 nd month. The secondary outcome was caregiver satisfaction on a questionnaire focusing on skill enhancement using Mann-Whitney tests at the end of 2 nd month. The exploratory outcome was survival benefit using Kaplan-Meier method with log rank hazard model from the enrollment to the death. The primary analyses were based on intention-to-treat principles, covering all patients who completed baseline assessment. False discovery rate (FDR) was used for multiple testing correction. Results: From Jul 28 to Nov 3, 2023, 154 eligible patients with family caregivers were randomly and evenly assigned to the intervention group and control group. 74 and 73 patients with their caregivers, in the intervention and control group respectively, completed baseline assessment. Among the 147 patients (mean age 59.9 years, 42.9% female) from baseline to the end of 2 nd month, Linear Mixed Model analyses showed that the intervention group had significant improvement of HRQoL compared with the control group, evidenced by EORTC QLQ-C30 score (FDR-adjusted p < 0.0001, Cohen’s d 0.42) and HAM-A score (FDR-adjusted p < 0.0001, Cohen’s d -0.43). There was a significant difference of caregiver satisfaction at the end of 2 nd month (mean difference score 0.57, p < 0.0001, Cohen’s d 1.19). Besides, a post-trial exploratory survival analysis showed that the intervention group had longer survival compared to the control group (median 220 days vs. 141 days, p = 0.012, hazard ratio 1.83, 95%CI 1.14 to 2.92) after adjustment of baseline characteristics. Conclusions: The fast-delivering and concise eDEI can enhance caring capability of family caregivers, improve physical and psychological aspects of HRQoL, and prolong survival among incurable cancer patients. Clinical trial information: 2300077346 .