Communication Training for Family Caregivers to Improve Engagement in Advance Care Planning

About This Grant

PROJECT SUMMARY In 2025, at least 63 million people in the U.S. served as family caregivers, the partners, relatives, and friends who care for patients with often life-threatening, incurable illnesses. Caregivers are increasingly tasked with responsibilities once performed by medical professionals, and the availability and health of caregivers is more critical than ever. The growing number of caregivers who provide care to patients with advanced, life-limiting cancers play a significant role in healthcare communication and advanced care planning (ACP). In fact, effective ACP often depends on caregivers who broker information between patients and healthcare professionals (HCPs). In the absence of ACP discussions, caregivers are generally unsuccessful in estimating treatment preferences, and poor communication magnifies these discrepancies, whereas open communication is associated with prognostic awareness and documented goals of care. Hence, equipping caregivers with the skills necessary to engage in vulnerable and productive ACP discussions and eventually, to advocate for their care partners' wishes, is critical to ensuring patients' interests are represented at the end of life. To date, however, there are no support programs or interventions for caregivers that explicitly target the communication skills necessary to engage in ACP discussions. We developed a Communication Skills Training Program for Caregivers (CT-C) to address caregivers' unmet communication skills needs. The brief two-hour training includes an overview of ACP, instruction in six communication skills, and role-play exercises using actors coached to portray patients and healthcare professionals. Results of our pilot randomized controlled trial demonstrated the CT-C's feasibility, acceptability, and superiority in improving distress, anxiety, and preparedness for death. In the proposed trial, we will more rigorously evaluate the efficacy of the CT-C through a randomized controlled trial of 200 caregivers of patients with advanced (Stage III/IV solid tumor) cancer who will receive either the CT-C or Enhanced Usual Care (EUC; distress screening and the provision of targeted referrals). Participants will undergo assessments of anxiety and the occurrence of ACP discussions with patients (primary outcomes), and ACP readiness, confidence in communication, distress, depression, dyadic coping and ACP discussions with HCPs (secondary outcomes) at baseline, 1-month, 6-months, and 12-months post-training. Bereavement outcomes including pre- and post-loss grief, preparedness for loss, and risk for bereavement mental health challenges will also be evaluated at each time point. While not a requirement for caregiver enrollment, the patients for whom caregivers provide care will be invited to complete assessments of advance directives completion, dyadic communication, and relationship quality with HCPs on the same timeline. We predict the CT-C will result in greater improvements in primary and secondary outcomes, and bereavement and patient outcomes. Our results will enhance our capacity to support caregivers in their roles as healthcare proxies, and by extension, improve their capacity to provide critical care to patients at end-of-life.