Date of Award

Summer 8-8-2014

Degree Type


Degree Name

Doctor of Social Work (DSW)

First Advisor

Zvi D. Gellis, PhD

Second Advisor

Holly Nelson-Becker, PhD

Third Advisor

Amy M. Corcoran, MD



Problem-Solving Therapy for Informal Hospice Caregivers: A Randomized Controlled Pilot Study

Christin Ann Gregory, LCSW, DSW Candidate, University of Pennsylvania

Problem: U.S. Hospice care is a growing service for the terminally ill, ever more important as our aging population expands. Informal caregivers are integral to the hospice philosophy, considered to be a part of the hospice unit of care. These caregivers are the major providers of hands-on and emotional care for the dying. They face shift in family role, loss of employment and personal time, and have been shown to suffer from increased mental and physical health issues as a direct effect of caregiving. The predominant unmet need of the hospice caregiver is psychological. The hospice social worker is the major provider of psychological services for the hospice caregiver, but at present, there is a lack of evidence-based research on caregiver interventions in this clinical setting.

Objectives: This study examined the feasibility and efficacy of Problem-Solving Therapy (PST) in improving mood, quality of life, and problem-solving skills for primary (informal) caregivers of home-based hospice patients.

Design: This study employed a randomized controlled design, comparing the effects of brief problem-solving therapy for hospice caregivers (PST-Hospice) and usual care plus caregiver education (UC+CE) on hospice caregiver outcomes. A baseline survey was collected after informed consent, followed by five weekly forty-five minute sessions of PST treatment or the provision of caregiver coping educational materials. Post-test surveys were administered post intervention completion (6 weeks). Qualitative interviews were also conducted to give voice to the caregiver experience.

Setting: This study was conducted between November 15th, 2013 and May 16th, 2014. Participants were gathered from home-based admissions at two South Jersey hospice agencies: one for-profit agency, and one not-for-profit agency.

Inclusion Criteria: (1) Primary informal caregivers, (2) Caring for patients who reside in a home residence or assisted living, (3) age 18 or older, (4) able to speak English, (5) willing to participate.

Measures: Demographic information (age, sex, gender, relationship to patient, marital status, ethnicity, employment, education, income, household number, patient diagnosis, assistance with care) was gathered pretreatment. Outcomes measured at pre-treatment and post-treatment (5 weeks post randomization) were: (1) The Brief Patient Health Questionnaire Mood Scale (PHQ-9), (2) The Caregiver Quality of Life Index- Cancer (CQOLC), (3) The Social Problem Solving Inventory-Revised Short Form (SPSI-R Short).

Data Analysis: 1) Descriptive statistics were gathered for demographic information. 2) T-tests and Chi-Squares were used to determine differences between groups. 3)To determine mean differences between conditions for primary outcome variables, t-tests were conducted. 4) Qualitative interviews with 3 study participants were completed to gain information about their experience being a part of this study.

Keywords: social work, hospice, palliative care, caregivers, problem-solving therapy, randomized trial, quality of life, social work interventions, evidence-based practice (EBP)