Badr, H., Smith, C.B., Goldstein, N.E., Gomez, J.E., & Redd, W.H. (2015). Dyadic psychosocial intervention for advanced lung cancer patients and their family caregivers: Results of a randomized pilot trial. Cancer, 121, 150–158. 

To test the initial efficacy, acceptability, and feasibility of a dyadic (patient–caregiver) psychosocial, phone-delivered intervention to improve the quality of life of the families of patients with advanced lung cancer within one month of the first cancer treatment

The dyads were randomly assigned to a usual medical care (UMC) or a six-week intervention group. Intervention patients and caregivers received separate standardized, tailored manuals. Manuals addressed self-care, stress and coping, symptom management, effective communication, problem solving, and maintaining and enhancing relationships. Patients and caregivers shared half of the topic information, but other content was tailored to the patient or caregiver role. Patients-tailored content included ways to balance autonomy with asking for and accepting support, sharing support needs, and ways to show caregiver appreciation. Caregiver-tailored content included ways to minimize patient overprotection, show effective communication, and ways to support patient self-care goals. Intervention dyads participated in six weekly 60-minute telephone counseling sessions aimed at alleviating caregiver burden with a trained interventionist who reviewed weekly patient and caregiver homework and manual content. The interventionist mentored participants through sessions and homework assignments to reinforce session skills for patients and caregivers. Participants in UMC and intervention groups completed six paper-and-pencil surveys at baseline and eight-weeks after baseline.

• N = 39 patient–caregiver dyads (20 dyads in intervention group, 19 dyads in UMC group)
• MEAN AGE = Patients; 68.17 years (SD = 10.30 years, range = 38–87 years), caregivers; 51.10 years (SD = 10.24 years, range = 35–70 years)
• MALES: Patients (26%); caregivers (31%), FEMALES: Patients (74%); caregivers (69%)
• KEY DISEASE CHARACTERISTICS: 84% of sample had stage 3 or 4 non-small cell lung cancer; 16% had extensive-stage small cell lung cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Patients were mostly white (85%) and educated with at least some college credits (86%); 62% was unemployed or retired; caregivers were mostly female (69%) and educated with at least some college credits (95%); most were middle-aged (mean = 51.10 years, SD = 10.24 years) and employed at least part- time (77%); 51% of caregivers were spouses or partners, and others were siblings or the adult sons and daughters of patients

• SITE: Single site
• SETTING TYPE: Outpatient oncology and palliative care clinic  
• LOCATION: New York City comprehensive cancer center with range of services

• PHASE OF CARE: Advanced lung cancer within one month of treatment initiation (any form of therapy)
• APPLICATIONS: Elder care and palliative care 

Randomized clinical trial

• Six-item Patient Reported Outcomes Measurement Information System (PROMIS), a short-form depression measure to assess the negative moods and views of self for the past week
• Two-item Zarit Burden Interview (ZBI) Short Form 
• Six-item Treatment Self-Regulation Questionnaire (TSRQ) to assess patient autonomy for engaging in self-care
• Five items developed by Pierce et al. used to assess caregivers’ autonomous motivation
• 38-item Likert scale measure based on the work of Lorig et al. (1996) used to measure competence (self-efficacy)  
• Four-item measure used to measure relatedness (quality of the caregiver-care recipient relationship)

The study's recruitment rate was 60%, which is comparable to rates reported in other telephone-based cancer dyadic interventions, supporting the feasibility of recruiting advanced LC patients on active treatment and their caregivers for this trial. Patient and caregiver telephone-session participation was 90%. Participants rated the intervention as relevant, convenient, and helpful. Retention was excellent, and dyads completed the majority (88%) of homework assignments. This suggests a highly acceptable intervention. Large effect sizes were found for the impact of the intervention on outcomes of patient and caregiver depression, anxiety, and caregiver burden as contrasted with UMC group outcomes. Large effect sizes for impact of the intervention were also found for additional patient and caregiver outcomes relevant to competence and relatedness and caregiver free choice to provide patient care. Highly depressed and anxious caregivers, identified at the baseline assessment in the intervention group, showed greater improvements in psychological functioning than did those in the UMC group.

This pilot study demonstrated the feasibility and acceptance of a six-session, telephone-based dyadic psychosocial intervention developed for patients with advanced lung cancer and their caregivers and its positive effects on their rates of depression, anxiety, and caregiver burden.

• Small sample (< 30)
• Baseline sample/group differences of import
• Measurement/methods not well described
• Other limitations/explanation: Sample was primarily white and was relatively well-educated; the ability to generalize findings to other populations was limited

Telephone-based interventions addressing patients with late-stage lung cancer and their caregivers may improve overall dyadic quality of life. This study indicated support for separate patient and caregiver sessions to address private issues posing challenges in a dyadic discussion. Additional research focused on separate sessions balanced with dyadic sessions may strengthen the evidence for telephone interventions.