Caregiver/Partner Interventions

Caregiver/Partner Interventions

PEP Topic 
Anxiety
Description 

Caregiver/partner interventions refer to provision of a specific intervention to a patient’s informal caregiver, spouse, or partner in an attempt to affect the patient's symptoms. Caregiver/partner interventions involving education and enhancing partner adjustment to the patient’s illness have been studied in patients with cancer in an attempt to manage patient anxiety.

Effectiveness Not Established

Research Evidence Summaries

Cochrane, B.B., Lewis, F.M., & Griffith, K.A. (2011). Exploring a diffusion of benefit: Does a woman with breast cancer derive benefit from an intervention delivered to her partner? Oncology Nursing Forum, 38, 207–214.

doi: 10.1188/11.ONF.207-214
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Study Purpose:

To provide preliminary data on the diffusion of psychosocial benefit (anxiety, depressed mood, and marital quality) for women diagnosed with breast cancer when only their partners received a psychoeducational intervention focused on the breast cancer experience

Intervention Characteristics/Basic Study Process:

Five group sessions focusing on stress-reduction and interpersonal communication were delivered to the patient’s partner. The program focused on enhancing partner adjustment to the breast cancer experience and skill training to enhance the diagnosed woman’s perceived support. Sessions focused on stress-reduction strategies, enhancing listening skills, and resisting a tendency to fix or reassure prematurely, along with nonverbal strategies to enhance their interpersonal connection.

Sample Characteristics:

  • The study reported on a sample of nine patients and their partners.
  • Mean patient age was 52.7 years (range = 32–69 years); mean partner age was 56.2 years (range = 37–68 years).
  • The sample was 100% female.
  • Patients had local or regional (stages 0–III) breast cancer. Time since breast cancer diagnosis was an average of 4.5 months.
  • All participants were Caucasian and had a total household income of more than $80,000 per year.
  • Average total years in the relationship was 26.7 (range = 5–44).

Setting:

  • Single site
  • Outpatient clinic
  • Pacific Northwest region of the United States

Phase of Care and Clinical Applications:

Patients were undergoing the diagnosis phase of care.

Study Design:

A pre/post-test design was used.

Measurement Instruments/Methods:

  • Spielberger State-Trait Anxiety Inventory (STAI) Form Y – state anxiety subscale
  • Center for Epidemiologic Studies – Depression scale (CES-D)
  • Dyadic Adjustment Scale – 32-item test to measure marital quality
  • Mutuality and Interpersonal Sensitivity Scale – 32-item cancer-specific measure of marital quality

Results:

Average patient state anxiety score improved from 44.1 preintervention to 31 postintervention (p = 0.01).

Conclusions:

There is preliminary support for a diffusion of benefit to the diagnosed woman when a psychoeducational intervention is delivered to her partner in terms of depression and anxiety.

Limitations:

  • The study had a small sample size.
  • The sample was homogenous, with high education and income levels.
  • The study had a high attrition rate (33%).

Nursing Implications:

Findings may not be applicable to other socioeconomic or education level groups.

Manne, S.L., Ostroff, J.S., Winkel, G., Fox, K., Grana, G., Miller, E., . . . Frazier, T. (2005). Couple-focused group intervention for women with early stage breast cancer. Journal of Consulting and Clinical Psychology, 73, 634–646.

doi: 10.1037/0022-006X.73.4.634
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Intervention Characteristics/Basic Study Process:

The intervention was a couple-focused support group intervention (90-minute group session over six weeks). The intervention consisted of enhanced support exchanges and coping skills between women with cancer and their partners. One group received the intervention and one group received usual care, which included social work consultations for all women and referral to a psychiatrist or psychologist if indicated. Assessments occurred initially, after the first group session, at the end of group session 6, and at six months for follow-up.

Sample Characteristics:

  • The study reported on a sample of 238 women with early-stage breast cancer who had undergone surgery within the past six months and their partners.
  • Patients had primarily ductal cancer (in situ, stage I, II, or IIIa), with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
  • Patients were married or living with a significant other.
  • Patients and partners were at least 18 years of age, able to give informed consent, and English speaking.

Study Design:

A longitudinal, randomized controlled trial design was used.

Measurement Instruments/Methods:

  • Mental Health Inventory-18 (MHI-18) – anxiety subscale
  • Impact of Event Scale
  • Partner Unsupportive Behavior Scale
  • Cancer Rehabilitation Evaluation System (CARES) – functional status subscale
  • Expectancy Rating Form (modified) given after group session 1
  • Borkovec and Naus’ Scale (expanded version) administered after group session 6
  • Survey assessing use of psychosocial care
  • Information on stage, treatment, and ECOG symptom ratings (obtained from medical chart; ECOG rating done by the patient’s physician)

Analysis evaluated subgroups of data using growth curves models approach with three-step procedure. For first step, time was considered the only explanatory variable. For second step, demographic, medical, site, treatment, and psychological covariates were examined. Third step examined moderator effects by crossing the intervention group main effect with time and the proposed mean-centered moderators. All multiple mean comparisons were adjusted with Tukey.

Results:

Women attending sessions reported significantly less distress and anxiety levels than did women receiving usual care or those who dropped out of the intervention (p = 0.0171). Findings suggest that women who rated their partners as more unsupportive and those who had greater physical impairment had an increased response to the intervention compared to women in the control group. Thirty-five percent dropped out of the intervention. Results via ITT analysis: First step (time) indicated significant decline in anxiety over time ([t344] = -2.21, p = 0.0280) and significant differences among participants both in preintervention anxiety (z = 8.02, p < 0.0001) and in the rates at which anxiety changed over time (z = 2.38, p = 0.0085). Second and third steps steps indicated that interactions involving the intervention group were not significant for anxiety. Effect sizes of intervention were small, ranging from 0.2 to 0.7.

Limitations:

Effect sizes were relatively small (0.2–0.7).


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