Leow, M., Chan, S., & Chan, M. (2015). A pilot randomized, controlled trial of the effectiveness of a psychoeducational intervention on family caregivers of patients with advanced cancer. Oncology Nursing Forum, 42, E63–E72. 

DOI Link

Study Purpose

To evaluate the efficacy of the Caring for the Caregiver Program (CCP) to enhance the quality of life of the caregivers of patients diagnosed with advanced cancer compared to caregivers who receive standard care

Intervention Characteristics/Basic Study Process

Participants were randomized to receive the intervention using CCP plus standard care or standard care from home Hospice providers. Two post-test measures were used at four and eight weeks postintervention. The CCP intervention was comprised of a one-hour, face-to-face session to develop a plan of care, a video clip, two follow-up phone calls, and an invitation to join an online social support group.

Sample Characteristics

  • N = 56
  • MALES: 26, FEMALES: 54
  • KEY DISEASE CHARACTERISTICS: Stage IV cancer prognosis of at least three months
  • OTHER KEY SAMPLE CHARACTERISTICS: Receiving Hospice care; English-speaking; greater than 21 years old; caregivers spent a minimum of 20 hours a week with patient; most participants were Chinese

Setting

  • SITE: Home  
  • SETTING TYPE: Four home Hospice and one outpatient clinic
  • LOCATION: Singapore

Phase of Care and Clinical Applications

  • PHASE OF CARE: End-of-life care (stage IV)
  • APPLICATIONS: Palliative care 

Study Design

Pilot-randomized, controlled trial with a two-group pretest and repeated post-test

Measurement Instruments/Methods

  • The Caregiver Quality of Life Index: Cancer (CQOLC)
  • Social Support Questionnaire (SSQ)
  • Depression Anxiety Stress Scale (DASS)
  • General Closeness Scale (GCS)
  • Self-Efficacy in Self-Care Scale (SESCS)
  • RC scale
  • Caregivers' perceived knowledge of advanced care planning and community resources (six-question Likert scale)

Results

Participants in the intervention group showed improvements in all of the data measured by the six scales employed.
 
The intervention group demonstrated an overall improvement in quality of life, social support, self-care, and perceived closeness with the patient. Participants who received the intervention also had lower levels of stress and anxiety. The intervention was successful through its employment of practical tips during the face-to-face visit and through watching the video. In addition, there was an overall improvement in feelings support and perceived improvement in social support. All outcomes showed a significant effect of group assignment (p < 0.05), and those in the intervention group reported high quality of life (p = 0.000) and self-efficacy (p = 0.000) scores.

Conclusions

The CCP had a positive effect on family caregivers providing care to patients with advanced cancer.

Limitations

  • Small sample (< 100)
  • Risk of bias (no random assignment): Per the author's discussion, random sampling method could lead to selection bias on participant characteristics
  • Risk of bias(sample characteristics): Only English-speaking patients were included
  • Findings not generalizable: Sample size could limit ability to generalize
  • Other limitations/explanation: RC scale was not clearly identified; authors should clearly state the source and validity of this scale

Nursing Implications

Identifying at-risk caregivers and implementing a CCP intervention can improve the experience of patients with an advanced diagnosis of cancer and their caregivers. These types of interventions have the potential to decrease caregiver strain and burden by improving access to social supports and improving knowledge and self-efficacy.