Demiris, G., Parker Oliver, D., Wittenberg-Lyles, E., Washington, K., Doorenbos, A., Rue, T., & Berry, D. (2012). A noninferiority trial of a problem-solving intervention for hospice caregivers: In person versus videophone. Journal of Palliative Medicine, 15, 653–660. 

To compare the effectiveness of problem-solving therapy delivered via videophone versus face-to-face sessions

Caregivers were randomized to the experimental or face-to-face sessions for the intervention. Three videophone calls or sessions were done during 5–18 days after hospice admission. The intervention involved addressing problems initially identified by caregivers, visualization of effective problem solving, positive self-talk, brainstorming approaches to problems, setting goals and solutions, planning action, and evaluating effectiveness of actions taken. A final exit interview was conducted to elicit caregiver perceptions of the intervention. A manual for the intervention was used, all face-to-face visits and videophone calls were audio recorded, and a 10% random sample of recording was evaluated for treatment fidelity.

• N = 126   
• MEAN AGE = 59.6 years
• MALES: 25%, FEMALES: 75%
• OTHER KEY SAMPLE CHARACTERISTICS: Most were Caucasian and highly educated. Fifty-nine percent of caregivers were adult children of the patient and, in the majority of cases, the patient resided with the caregiver.

• SITE: Single site   
• SETTING TYPE: Multiple settings    
• LOCATION: Washington

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care

Noninferiority, randomized, two-group trial

• Caregiver Quality of Life Index-Revised (CQLI-R)
• State-Trait Anxiety Inventory (STAIS); a six-point change was selected for measurement of noninferiority.
• Problem Solving Inventory (PSI)

Anxiety reduced significantly in both groups (p < 0.0001). The difference in the video group was not inferior to that in the face-to-face group, and the actual change in anxiety score was greater in the video group. No changes or differences occurred between groups in other study measures.

Delivery of problem-solving therapy, a cognitive behavioral therapy approach, by videophone was not inferior to delivery by face-to-face sessions.

• Risk of bias (no blinding)
• Subject withdrawals ≥ 10% 
• Participants mainly lost to follow-up because of patient death

The findings showed that a problem-solving intervention was effective to reduce stress in informal caregivers of patients in hospice, and the delivery of the intervention by videophone was not inferior to delivery by face-to-face sessions. Delivery of these types of interventions with technology can be a practical alternative to traditional methods of intervention.