Laudenslager, M.L., Simoneau, T.L., Kilbourn, K., Natvig, C., Philips, S., Spradley, J., . . . Mikulich-Gilbertson, S.K. (2015). A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: Effects on distress. Bone Marrow Transplantation, 50, 1110–1118. 

To determine if a modified cognitive behavioral stress management program would have a beneficial effect for caregivers on stress reduction

Caregivers were randomized to either the experimental intervention or usual care groups. The experimental intervention consisted of eight one on one sessions with a social worker beginning post-transplantation and continued weekly prior to evaluation at three months. Sessions were psychoeducational in nature, including coping skills training, health behaviors, improving partner communication, and relaxation as well as other components. Caregivers in the experimental group were given a biofeedback device and asked to use it four to five times weekly to facilitate relaxation. All caregivers from both study groups were encouraged to participate in programs at the facility designed to provide support for patients, families, and caregivers. Study data were obtained at baseline, one month, and three months.

• N = 122 (four weeks); 101 (12 weeks)  
• MEAN AGE = 53.5 years (range = 21–80 years)
• MALES: 23.6%, FEMALES: 75.7%
• KEY DISEASE CHARACTERISTICS: All patients were undergoing hematopoietic stem cell transplantation.
• OTHER KEY SAMPLE CHARACTERISTICS: Most caregivers were spouses or partners, and 48% were employed full-time prior to caregiving.

• SITE: Not stated
• SETTING TYPE: Multiple settings

• PHASE OF CARE: Active antitumor treatment

Randomized, controlled trial

• Perceived Stress Scale (PSS)
• Center for Epidemiological Studies (CES) depression scale
• State-Trait Anxiety Inventory (STAI)
• Caregiver Reaction Assessment (CRA)
• Profile of Mood States (POMS)
• Pittsburgh Sleep Quality Index (PSQI)
• Short Form 36 (SF-36)
• A caregiver composite distress score was created from component analysis on variables in study questions for both affective and physical well-being variables.

Baseline results showed higher than normal perceived stress, clinically relevant levels of depression, elevated anxiety, and poor sleep in caregivers. Caregivers in the intervention group had lower stress at three months (p = 0.039) and consistent declines in depression (p = 0.016) and anxiety scores (p = 0.0009) over time compared to controls. There were no differences between groups over time in measures of physical function and well-being. The composite score for caregiver distress was significantly lower among those in the intervention group (p = 0.019).

The psychoeducational intervention tested here demonstrated benefit in the reduction of caregiver psychological distress, depression, and anxiety.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)  
• Risk of bias (sample characteristics)

The findings of this study demonstrated that psychoeducational interventions can be helpful to caregivers in reducing the psychological components of caregiver stress and burden. Educational and supportive interventions are low-risk and can be provided to caregivers in a variety of ways. Reducing caregiver burden can improve their well-being and permit the caregiver to be more effective in fulfilling care needs.