A lay coach-led telehealth palliative care programme did not significantly improve caregiver or patient outcomes at 24 weeks compared with usual care, according to a randomised clinical trial published in JAMA Network Open.
However, exploratory analyses suggested the intervention may benefit caregivers who entered the study with higher levels of distress, suggesting that targeted support for caregivers with elevated baseline distress warrants further investigation.
Family caregivers of people with advanced cancer often provide extensive emotional, practical and medical support while managing their own health and wellbeing. African American and rural-dwelling caregivers may face additional barriers to accessing supportive care, including geographic isolation and limited availability of specialist services.
REGISTER FOR BREAST CANCER TRIAL’S ANNUAL SCIENTIFIC MEETING | JULY 2026
Researchers conducted what the authors describe as the largest randomised clinical trial to date involving African American and rural-dwelling family caregivers of patients with advanced cancer. The single-blind trial enrolled 222 family caregivers and 165 patients receiving care at two outpatient oncology centres in the southeastern United States.
Participants were randomly assigned to receive either the ENABLE Cornerstone programme or usual care. The intervention consisted of six weekly telephone-based psychosocial coaching sessions delivered by trained lay coaches, followed by monthly follow-up calls. Usual care included informational resources routinely provided by the participating cancer centres.
The primary outcome was caregiver distress at 24 weeks, measured using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included caregiver and patient quality of life, caregiver burden and patient distress.
At 24 weeks, there were no statistically significant differences between the intervention and usual care groups for the primary outcome. The mean baseline-adjusted difference in caregiver anxiety scores was 0.23 (P = .60), while the difference in depressive symptom scores was 0.04 (P = .91).
Similarly, no statistically significant improvements were observed in caregiver quality of life, caregiver burden or patient-reported outcomes at the primary study endpoint.
The investigators also conducted an exploratory sensitivity analysis among caregivers who reported elevated distress at baseline. In this subgroup, the intervention was associated with potential improvements in caregiver anxiety and patient mental health-related quality of life, although differences in caregiver burden and patient depression did not reach statistical significance.
According to the authors, the findings suggest the intervention did not improve outcomes overall, although targeted support for caregivers experiencing greater distress may warrant further investigation. They noted that many caregivers enrolled in the study had relatively low levels of distress at baseline, which may have limited the ability to detect an intervention effect. They also acknowledged that the study was conducted at two academic cancer centres with established supportive care services and that a substantial proportion of participants did not complete all intervention sessions.
The authors concluded that the ENABLE Cornerstone programme did not improve caregiver or patient outcomes overall at 24 weeks. However, the exploratory findings support further research into distress screening and targeted palliative care interventions for family caregivers most likely to benefit.
Paper: Odom JNAzuero ATaylor RA, et al. Palliative Care Coaching for Family Caregivers of Patients With Advanced Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(6):e2619807. Access online here.
