Hendrix, C.C., Bailey, D.E. Jr., Steinhauser, K.E., Olsen, M.K., Stechuchak, K.M., Lowman, S.G., . . . Tulsky, J.A. (2015). Effects of enhanced caregiver training program on cancer caregiver's self-efficacy, preparedness, and psychological well-being. Supportive Care in Cancer, 24, 327–336. 

To examine the effects of enhanced training on caregivers’ self-efficacy in managing patients' symptoms, stress, preparedness for caregiving, depression, and anxiety

Researchers structured and used enhanced caregiver training (CT) that taught caregivers how to manage patients’ symptoms and their own stress. This training added distress management to previously developed training that focused on managing patients' symptoms only. Training was done at the patients' bedside, one on one, with dyads (patients and their caregivers), and required one to two hours. Training on symptom management involved a manual process that started with a needs assessment to tailor the training to the patient’s situation, an interactive discussion that involved both the patient and the caregiver about how to manage symptoms, and concluded with a one-page hand out on each symptom. Training related to caregivers’ stress management involved a three-step behavioral rehearsal procedure. The nurse modeled how to implement the skill, and the caregiver practiced the skill and received constructive feedback. Finally, the caregiver practiced until she or he mastered the skill.

• N = 38 (intervention); 38 (control)
• AVERAGE AGE = 55 years (caregivers)
• MALES: 18%, FEMALES: 82%
• OTHER KEY SAMPLE CHARACTERISTICS: The majority of caregivers were adults, Caucasian, married, had at least some college education, and were the spouses of patients. The majority had a high level of health literacy, and the average length of caregiving was 19 months. A dyad was excluded if a patient was under hospice care.

• SITE: Single site    
• SETTING TYPE: Inpatient  
• LOCATION: Duke University Health System Oncology Units

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

Randomized, controlled trial in which the intervention arm received enhanced CT and the control group received information about community resources

• Modified Caregiver Self-Efficacy Scale (CaSES) to assess confidence in caregiving abilities (13 items) and in stress management (one item)
• The Preparedness for Caregiving Scale (PCS), a subscale of the Family Caregiving Inventory (FCI)
• Profile of Mood States (POMS) to assess anxiety
• Center for Epidemiologic Studies–Depression (CES-D) scale
• Caregiver Reaction Assessment (CRA) to assess caregiver burden
• Rapid Estimate of Adult Literacy in Medicine (REALM-R) to assess health literacy

Significant difference was identified between the intervention and control groups in self-efficacy for managing patients' symptoms, caregiver stress, preparedness for caregiving immediately after the intervention. The intervention group scored higher on the previous outcomes. No differences in other outcomes were found, and the differences initially observed after the intervention were not sustained at two and four weeks after discharge.

Enhanced CT improved caregivers’ self-efficacy, stress management, and preparedness for caregiving immediately after the intervention. However, it did not lead to significant changes in anxiety, depression, or burden. No sustained effects of the intervention were observed for any outcomes.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%  
• Other limitations/explanation: This was a well done trial despite the identified limitations.

Caregiver training given in a single dose may not be the best approach to improving caregiver outcomes. Training or interventions for caregivers should be tailored based on emerging needs after discharge, and they should not be exclusively based on the observed or anticipated needs prior to a patient's discharge from the hospital.