Chambers, S.K., Girgis, A., Occhipinti, S., Hutchison, S., Turner, J., McDowell, M., . . . Dunn, J. C. (2014). A randomized trial comparing two low-intensity psychological interventions for distressed patients with cancer and their caregivers. Oncology Nursing Forum, 41(4), E256–E266. 

To compare the effectiveness of nurse- and psychologist-delivered psychoeducational interventions for distressed patients and caregivers who had called a cancer helpline seeking support

Individuals who called the helpline were randomized to a five-session psychologist intervention using a cognitive behavioral approach or a single nurse-delivered session for education and support for self-management. All sessions were provided by telephone. Those in the single-session group were mailed a self-management resource kit, including written advice about stress management, problem solving, healthy lifestyle, and mobilizing support networks, along with an audio CD about relaxation exercises. All participants completed a baseline distress thermometer, and those who had a score of 7 or greater also received a follow-up phone call after the nurse session three weeks later. Study measures were obtained at baseline and at 3, 6, and 12 months. Caregivers and patients were not dyads because helpline calls were done individually.

• N = 132 caregivers   
• MALES: 12%, FEMALES: 88%
• KEY DISEASE CHARACTERISTICS: Various tumor types; disease stages and phase of care not reported
• OTHER KEY SAMPLE CHARACTERISTICS: 42% of caregivers were spouse or partner.

• SITE: Multi-site  
• SETTING TYPE: Home  
• LOCATION: Australia

• Randomized, two-group trial

• Distress Thermometer
• Brief Symptom Inventory-18
• Impact of Event Scale 
• Post-traumatic Growth Inventory for perceived positive life changes 

Of the patients and caregivers, 93% completed the single-session intervention and 53% completed all five psychologist interventions. In the nurse arm, the mean intervention duration was 46.51 minutes, and the psychologist mean session duration was 46.43 minutes. Distress-related outcomes decreased over time, and positive adjustment increased over time in both groups. Effects size over 12 months was 0.19 in the nurse intervention group and 0.2 in the psychologist group. Cancer-specific distress decreased significantly over time for caregivers (p < .001), and positive adjustment increased (p < .001) with no significant difference between groups. Thirty-five percent of those in the nurse group received a follow-up phone call because of their distress score, and 3% were referred for additional support services.

Both the brief nurse contact for psychoeducation and self-management support and the telephonic CBT approach interventions provided by a psychologist were associated with reduction in distress and improvement in positive adjustment among caregivers of patients with cancer who had contacted a cancer helpline.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Measurement/methods not well described
• Other limitations/explanation: With some instruments, whether only subscales were used in the study is not clear.

Findings suggest that caregivers, as well as patients, can benefit from a single-session nursing psychoeducational session provided by telephone and supported by self-management resource materials. Findings also showed that five telephonic sessions provided by a psychologist with a CBT approach also were helpful. Specifically, cancer-related distress can be approached effectively with a short, practical telephonic intervention for patients who identified a need for support by calling a helpline. Although this study has some design limitations in terms of sampling frame, it is very applicable for a real-world situation.