Dockham, B., Schafenacker, A., Yoon, H., Ronis, D.L., Kershaw, T., Titler, M., & Northouse, L. (2015). Implementation of a psychoeducational program for cancer survivors and family caregivers at a Cancer Support Community affiliate: A pilot effectiveness study. Cancer Nursing. Advance online publication.  

To examine the effectiveness and feasibility of the Family involvement, Optimistic attitude, Coping effectiveness, Uncertainty reduction and Symptom management (FOCUS) program on the quality of life (QOL), benefits of illness and caregiving, communication, and support of cancer survivors and their caregivers in a cancer support community (CSC) site using a small group format

Researchers modified the FOCUS program (a nurse-delivered, home-based intervention for patient/caregiver dyads) for use and administration by social workers at a CSC site to cancer survivors and their caregivers. The program was administered in six sessions over six weeks to three to four dyads in a small-group format.

• N = 34 dyads
• AVERAGE CAREGIVER AGE = 53.4 years (range = 31–70 years)
• MALES: 65%, FEMALES: 35%
• KEY DISEASE CHARACTERISTICS: Cancer survivors were defined as any person who received a diagnosis of cancer from the time of initial diagnosis until his or her death. Any type or stage of cancer was admissible in the sample as long as other eligibility criteria were met.
• OTHER KEY SAMPLE CHARACTERISTICS: The majority of caregivers were males, spouses of survivors, married, Caucasian, highly educated, and in good to excellent health.

• SITE: Single site    
• SETTING TYPE: Other    
• LOCATION: CSC in Ann Arbor, MI

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Elder care

Pre- and postintervention study with no control group

• Functional Assessment of Cancer Therapy–General (FACT-G) to assess quality of life (primary outcome)
• Benefits of Illness Scale (BIS) to assess perceived benefits of illness or caregiving
• Mutuality and Interpersonal Sensitivity Scale (MISS) to assess dyadic communication
• Cancer Self-Efficacy Scale (CASE) to assess self-efficacy
• All measures appeared to have sufficient reliability and validity.
• The feasibility of the modified FOCUS program was assessed by rates of enrollment, retention, intervention fidelity, and participants’ satisfaction. 

The intervention effect was assessed by dyadic scores (survivors and caregivers were treated as a unit). Dyadic QOL (physical, emotional, and functional) was significantly improved from preintervention to postintervention, but there was no improvement in social QOL. Dyadic perception of illness and self-efficacy also were significantly improved, but dyadic communication and support were not. The dyadic main effect size ranged from small to moderate for different outcomes. Effect sizes were larger for survivors than for caregivers. For feasibility, the enrollment rate was 60%, retention was 92%, and the intervention fidelity was 94%. Caregivers and survivors were highly satisfied with the intervention.

The modified FOCUS program was feasible and effective when administered to small groups of survivor/caregiver dyads. However, the assessment of improvement in outcomes considering the dyad a unit may lead to confusion in interpreting the outcomes of specific participants (survivors versus caregivers). 

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results 
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: This was a well done study despite the identified limitations.

Tailored interventions to assist caregivers are effective. Collaborations with community settings that allow for the administration of evidence-based programs assisting caregivers may make such interventions more feasible and available to larger numbers of patients and caregivers. Careful attention to intervention fidelity is essential when programs are translated on a larger scale.