Hendrix, C.C., Landerman, R., & Abernethy, A.P. (2013). Effects of an individualized caregiver training intervention on self-efficacy of cancer caregivers. Western Journal of Nursing Research, 35, 590–610.

 

To (a) investigate the effects of an individualized caregiver training intervention on a caregiver’s self-efficacy in home care and symptom management, and (b) identify whether caregiver training would affect a caregiver’s psychological well-being (depression, anxiety, and quality of life)

After signing informed consent, dyads completed baseline questionnaires and were randomly assigned to either a treatment group or a control group. Interactive nurse–caregiver training for one to two sessions was offered when discharge was imminent. Immediately after caregiver training, caregivers completed questionnaires on self-efficacy. Follow-up questionnaires for caregivers and patients were completed at one week, two weeks, and four weeks after hospital discharge of patients.

The caregiver training intervention provided caregiver training for managing patients’ cancer symptoms with four major components: (a) prevention of infection, (b) pain control, (c) maintenance of nutrition, and (d) adequate elimination. The program was manualized, including a book for caregivers with “how to” pictures. Additional time and content were allocated to address specific homecare issues identified by caregivers. The training followed a consistent outline, but information shared was specific to needs of the patient and caregiver.

The control intervention consisted of an interactive nurse–caregiver standardized, manualized one-two session intervention focused on information about community resources for caregiving. This included but was not limited to home health agencies, respite care, and caregiver support services.

• The sample included 120 patient dyads (60 in treatment group and 60 in control group).
• Of the caregivers, 48% were 46–64 years of age; of the patients, 54% were 60–69 years of age.
• The caregiver sample was 17% male and 83% female; the patient sample was 71% male and 29% female.
• Patients had hematologic malignancies.
• Of the caregivers, 84% were white, 89% were married, 60% had education beyond high school, 64.6% were not working outside the home, and the patient for whom they cared was a spouse.
• Of the patients, more than 80% were white, 88% were married, and almost 90% had education beyond high school.

• Single site
• Outpatient setting
• Duke University Hospital in Durham, NC

• Multiple phases
• Home care; after hospital discharge; survivorship

A randomized controlled trial design was used.

• Lorig’s Self-Efficacy Scale: Noted prior assessed reliability (0.94) and validity
• Hospital Anxiety and Depression Scale (HADS): No noted prior reliability and validity
• Older Americans Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire (Instrumental and Physical subscales): No noted reliability and validity
• OARS Comorbidity Scale: No noted reliability and validity indices
• Caregiver Quality of Life–Cancer Scale (CQOLC): Noted earlier assessed internal consistency of 0.91   
• Memorial Symptom Assessment Scale (MSAS): No noted reliability and validity

There was increased self-efficacy immediately following the caregiver training intervention and higher self-efficacy and symptom management at four weeks after the intervention when compared to the control group. A significant group-by-time interaction (p = 0.008) was present in the training intervention caregiver group that showed decreased depression scores from baseline to time 3 (one week). However, significant differences between treatment and control groups were not found after time 3. A similar result occurred when analyzing the effect of the intervention on caregiver anxiety. In terms of the effect of the caregiver intervention on patient’s physical symptoms, the overall intervention over time did not significantly improve symptoms. There was also no significant effect of the intervention on caregiver quality-of-life scores in both the control and caregiver training groups.

Caregivers have a major role in the outcome of a successful transition from hospital to home. This study provides information about caregiver training that improved their self-efficacy when addressing symptom management of a family member with cancer. More research is needed to determine the most effective caregiver training to manage patients’ symptoms at home.

• Nurses delivering the caregiver training intervention and the control intervention were not blinded.
• Assessment of the delivery of control and caregiver training intervention did not occur.
• The sample was mostly white, educated, and married.
• Caregivers were not observed providing actual home care and symptom management interventions.

Caregiver training for the patient’s home care and symptom management is critical in bridging the transition for patients from hospital to outpatient care. Nurses play a key role in this caregiver training tailored to specific caregiver and patient needs. Evidence-based information about the most effective training, including decisions about frequency, dosing, timing, formatting of information, and preparation of the nurse, is needed to improve caregiver quality of life and psychological well-being.