Nejad, Z.K., Aghdam, A.M., Hassankhani, H., & Sanaat, Z. (2016). The effects of a patient-caregiver education and follow-up program on the breast cancer caregiver strain index. Iranian Red Crescent Medical Journal, 18(3), e21627. 

To assess the benefit of an intervention of two face-to-face education sessions at the bedside and four interventions for patients with breast cancer and their caregivers

Sixty patients with breast cancer and their caregivers (60 pairs) were randomized to either the usual care group or the intervention group. Both groups received a comprehensive medication review and education after the pretest. The intervention group received two face-to-face education sessions reviewing a booklet that discussed patient needs; informational needs, such as nutrition, medication, rest, and activity; and chemotherapy side effect management, as well as four telephone calls assessing educational needs, followed by a post-test three weeks later.

• N = 60 patient–caregiver pairs   
• AGE: 30–50 years
• MALES (%): Not described, FEMALES (%): Not described
• CURRENT TREATMENT: Chemotherapy. Patients with breast cancer referred to the Hematology and Oncology Research Center of Tabriz University of Medical Sciences 
• KEY DISEASE CHARACTERISTICS: Patients newly diagnosed with breast cancer and new to chemotherapy

• SITE: Single site. Recruitment from the Hematology and Oncology Research Center of Tabriz University of Medical Sciences (patients treated at a large hematology/oncology research center in Northwest Iran)
• SETTING TYPE: Outpatient 
• LOCATION: Iran

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Palliative care 

• Randomized, experimental, two-group design (blinding to the research designer)

• Caregiver Strain Index Questionnaire-12 items (yes/no)

The mean caregiver strain score of the intervention dropped from 8.3 (SD = 2) to 2.3 after the intervention. The paired t-test results indicated that both the intervention and control groups were statistically different after the intervention in terms of caregiver strain scores (p < 0.001).

The caregiver group that received the intervention showed a statistical improvement in the pretest/post-test caregiver scores. The results showed an impressive improvement in the reduction of caregiver strain.

• Small sample (< 100)
• Findings not generalizable
• Small group
• The authors mentioned that the recruitment of patients newly diagnosed with breast cancer might have swayed the results.

The authors described a benefit from an oncology nurse-focused intervention to decrease caregiver strain and burden. This intervention lacked specificity. Further areas of exploration should be depression, anxiety, and future use of additional tools to assess the effectiveness. Future studies should obtain larger sample sizes.