Question: Does a symptom and psychosocial collaborative care intervention for patients with symptomatic heart failure (HF) and their informal (family) caregivers improve caregiver depression, burden, or ability to find caregiving benefits (benefit finding)?
Methods: The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) trial randomized 317 patients with HF and 101 of their caregivers to either usual care or the CASA intervention. The CASA intervention consisted of symptom and psychosocial collaborative care for patients provided by a nurse and social worker, respectively, who worked with patients’ primary care providers and were supervised by a study primary care provider, cardiologist, and palliative care physician. The social worker offered caregivers in the CASA intervention psychosocial assessment and treatment. Caregiver outcomes (depression, burden and benefit finding) were measured at baseline and 12 months.
Results: Caregivers were mostly female (N=77/101) with mean age 57.3 ± 15.7 years. Most caregivers were the patient’s spouse (N=58/101) or child (N=25/101) (Table 1). Of caregivers in the intervention arm, N=38/56 had at least one social worker visit, with variability in the number and duration of visits (Table 1). Caregivers faced diverse issues, such as need for self-care, difficulty adjusting to loved one’s illness, and bereavement. There were no significant changes in depression, burden or benefit finding between CASA intervention and control (Table 2).
Conclusion: The CASA intervention did not improve caregiver outcomes. Besides addressing challenges to caregiver recruitment and participation, future studies should consider the diverse issues faced by caregivers of patients with HF.