Bevans, M., Castro, K., Prince, P., Shelburne, N., Prachenko, O., Loscalzo, M., . . . Zabora, J. (2010). An individualized dyadic problem-solving education intervention for patients and family caregivers during allogeneic hematopoietic stem cell transplantation: A feasibility study. Cancer Nursing, 33(2), e24–e32.

To evaluate the feasibility of providing an individualized problem-solving education intervention to patient-caregiver dyads during stem cell transplantation

The intervention was based on the COPE model involving creativity, optimism, planning, and expert information. Sessions used an active problem identified by each dyad to apply the COPE problem solving model. The clinician interventionist guided the dyad in problem identification, review of related expert information, and development of a plan to address the problem. Scripting, peer supervision, and session audiotapes were used to ensure integrity of the intervention. Data were collected with a log and subject interviews. Audiotaped interviews were transcribed for analysis, and a second transcriber did quality monitoring on 100% of the tapes to ensure accuracy and completeness. Four sessions were provided—prior to transplantation, at the time of hospital discharge, two weeks after discharge, and four weeks after discharge. Dyads also attended usual admission and discharge education classes provided as part of usual care. Data collection occurred at baseline, each of these time points, and six weeks after initial hospital discharge.

• The sample included eight dyads (patient and spouse pairs).
• The mean age of patients was 56.5 ± 7.9, and the mean age of caregivers was 53.9 ± 9.67.
• Females made up 25% of patients and 62.5% of caregivers.
• Males made up 75% of patients and 37.5% of caregivers.
• Non-Hodgkin Lymphoma was the most prevalent cancer type.
• Eastern Cooperative Oncology Group (ECOG) performance status was 0 in 37.5%, 1 in 50%, and 2 in 12.5%.
• Initial hospitalization for transplantation was a median of 14.5 days (range 11–29).
• 63% required hospital readmission during the study period.
• Overall, subjects and caregivers reported levels of symptom distress suggesting a low symptom burden.
• All caregivers were the patients' spouses.
• The study period was the acute episode of care.

• Single site
• Inpatient and outpatient setting
• Transplant unit in Maryland
• Large research center

A single group repeated measures mixed method design was used.

• Brief Symptom Inventory (BSI)
• Social Problem-Solving Inventory (SPSI-R)
• Family Adaptability and Cohesion Evaluation Scale (FACES-IV)
• Symptom Distress Scale (SDS)

Ninety-four percent of scheduled sessions were completed. Session length was a median of 45 minutes, ranging from 15–60 minutes. Clinicians reported session scheduling as the greatest challenge.

Themes that emerged from qualitative analysis were “opportunity to talk,” “expert information,” and “creative thinking.” Effect sizes for each measure for patients and caregivers over time were reported. Subjects’ SPSI-R scores were within normative group range, suggesting effective problem solving ability prior to the intervention. Patient baseline distress was significantly related to a change in SPSI-R scores over the course of the study (r = 0.8, p = 0.031). It was noted that the caregiving experience was not limited to a spouse, and the study experience pointed to the need to expand the network to all those involved. Effect sizes of change in measures were provided, but there were no differences in outcomes over time.

Provision of this type of intervention appears to be feasible, and although scheduling sessions was shown to be challenging to clinicians, a high proportion of sessions were completed. The study provides some initial effect size data in the outcome variables measured. Authors identified the need to include a broader network of caregivers and further explore alternative timing and scheduling approaches for this type of intervention.

• The sample had less than 30 participants. This was a small feasibility study, and although some effect size data was gained, the sample was very small.
• The sample was a fairly homogenous ethnic group.
• A study goal was to determine feasibility, but there was no control or comparison group.
• The full study period was a relatively short period of time, encompassing mainly the acute episode of care.

Findings suggest that provision of individualized counseling and problem solving sessions using the COPE model is feasible with patients who have undergone stem cell transplant. In provision of caregiver support, nurses need to consider involving a number of caregivers because the network of individuals who are involved is often beyond a dyad. A broader involvement may also be helpful in dealing with session scheduling difficulties because of competing spouse priorities. Further research is warranted to evaluate effect sizes, different dosage, and timing of such interventions and involving various cultural groups. Further research including control groups is warranted as other similar studies have shown improvement in various patient and caregiver measures as a function of time alone.