The Effect of the Care Ecosystem Collaborative Care Model on End-of-Life Outcomes for People With Dementia and Their Caregivers.

The end-of-life analysis included only caregivers of people who died during the trial and completed surveys, so it does not represent all 804 dyads enrolled. Caregiver outcomes before death and end-of-life satisfaction and hospice outcomes came from different survey sets (214 pre-mortem caregivers; 65 usual care and 124 Care Ecosystem post-mortem caregivers). Research coordinators were unblinded for post-mortem surveys, and satisfaction and hospice data were collected after death. The Care Ecosystem intervention did not include specific end-of-life care protocols beyond advance care planning. Response rates were 81% for pre-mortem and 72% for post-mortem surveys, and non-respondents may have had different experiences. Qualitative questions were added only in February 2020 and were answered by 26 usual care and 43 Care Ecosystem caregivers; many deaths occurred during the height of the COVID-19 pandemic. Participants were excluded if they had life expectancy less than 3 months or lived in a nursing home at enrollment, so results may not apply to those settings.

The supplied text does not state who funded the study. Dr Bruce Miller reported scientific advisory board roles, external advisory committee roles, royalties, editorial roles, and grants from NIH and the Bluefield Project to Cure FTD; no other disclosures were reported.

Do not conclude that the Care Ecosystem improved end-of-life care. It did not improve caregiver satisfaction with care in the last 3 months, and it did not change hospice use; the positive finding was higher caregiver self-efficacy before death.