The Power of Human Connection (FR441B)

Abstract

•Recognize the importance of therapeutic alliance between caregivers and oncologists in the care of cancer patients.•Describe the relationship between caregiver-oncologist therapeutic alliance and the caregiver bereavement experience. The therapeutic alliance (TA) between oncologists and patients with cancer has been associated with an array of end-of-life (EOL) outcomes, but we are aware of no studies on TA between oncologists and cancer caregivers. To examine the associations between caregiver-oncologist TA and cancer caregiver bereavement outcomes. We conducted secondary analyses of data collected in the Values and Options in Cancer Care (VOICE) study, a randomized clinical trial aimed at improving quality of communications between oncologists and patients with advanced cancer and their caregivers. Having previously reported the intervention’s effects on patient outcomes, we now report secondary analyses, focusing on the effects of caregiver-oncologist TA on bereavement outcomes in 102 caregivers. Shortly after study entry, we assessed TA using the Human Connection Scale. Two months after death of the patient, we assessed caregiver-reported experiences of EoL care using the Quality of Death scale (QOD), Caregiver Evaluation of the Quality of End-Of-Life Care (CEQUEL) and the Modified Decision Regret Scale. Seven months after death of the patient, we assessed for Prolonged Grief symptoms (PG-13) and Purpose in Life (PIL). We conducted multivariable regressions examining associations between TA and outcomes after adjusting for study design variables (e.g., intervention arm, study site) as well as caregiver age, patient gender, patient education, and whether patients lived with their caregivers. TA was significantly associated with higher QOD (p=0.01), CEQUEL (p<0.005), and less decisional regret (p<0.01). The relationships between TA and PG-13 (p=0.60) and PIL (p<0.1) were not statistically significant. A stronger TA between caregivers and oncologists was associated with better caregiver perceptions of the quality of the patient’s EOL care, and serves an important role in helping caregivers navigate the complicated environment of cancer treatment.