Sherwood, P.R., Given, B.A., Given, C.W., Sikorskii, A., You, M., & Prince, J. (2012). The impact of a problem-solving intervention on increasing caregiver assistance and improving caregiver health. Supportive Care in Cancer, 20, 1937–1947.

To evaluate whether participation in a problem-solving intervention influences level of caregiver assistance with patient symptoms, caregivers’ depressive symptoms, burden mastery, and caregiver/patient communication at 10 and 16 weeks postparticipation

Caregivers in the dyads assigned to the intervention group received three telephone calls from a master’s-prepared nurse to assist them in assessing and managing patient symptoms. Both the intervention and control groups received written materials on these topics, and control group caregivers received calls from a non-nurse coach who reminded them of applicable content sections of the written materials. Measures were obtained at baseline, 10, and 16 weeks. Both groups received a symptom management toolkit containing written materials on symptom assessment, communication, and symptom management. Intervention group caregivers received three phone calls from a nurse to assist in identifying and managing symptoms; control group caregivers received calls from a non-nurse coach who reinforced the material in the toolkit.
 

• The sample was comprised of 225 caregiver/patient dyads.
• Mean caregiver age was 53.8 years (SD = 12.7) in the intervention arm and 56.1 years (SD = 13.1) in the control arm. Ranges were not reported.
• The intervention arm had 47 males (SD = 41.96) and 65 females (SD = 58.04); the control arm had 43 males (SD = 38.05) and 47 females (SD = 41.96).
• Patients were 40 years or older, without cognitive impairments; were English-language users; had touch-tone telephone service; had stage III or IV solid tumors; were not on hospice; and had a family caregiver.
• Patients had to be actively receiving chemotherapy during the study and report both pain and fatigue within seven days prior to recruitment.
• Patients under the care of a psychiatrist or psychologist were excluded.

• Multisite 
• Home setting
• Telephone intervention

Active antitumor treatment phase

A randomized controlled trial design was used.

• Cancer Symptom Inventory
• Caregiver Symptom Involvement (developed for study)
• Center for Epidemiologic Studies–Depression Scale (CES-D)
• Caregiver Reaction Scale (caregiver burden)
• ENRICH Marital Inventory–Family Communication Subscale
• Pearlin Mastery Scale

The statistically significant effect observed in the study related to a differential effect of depression in the intervention arm at the 10-week time point, where caregivers with lower levels (less than 16 on the CES-D) were twice as likely to provide an intervention for patient symptoms than those with a higher depression score (OR = 1.99, 95% CI = 1.45–2.76). Caregiver self-esteem was also statistically significantly different in the intervention arm (p = 0.04), but the authors noted that in the clinical context, this finding was likely due to chance.

Although no significant differences were noted overall between the nurse-led intervention and the control group, knowledge was gained regarding the impact of caregiver depressive symptoms on the degree of interventions offered to the patient with cancer experiencing symptoms. Future research may focus on tailoring interventions based on dynamic characteristics such as degree of caregiver distress concurrent to increasing patient symptom needs.

The study had risk of bias because the sample was described as primarily Caucasian: The authors cited literature noting variances in caregiver emotional responses by race, which might have implications given the findings associating depressive symptoms and caregiver responsiveness.

The authors speculated that caregivers with higher levels of depressive symptoms may be less able to act on behalf of their family members who are patients. In practice, nurses should assess whether caregiver distress may impact outcomes such as medication adherence and effective symptom reporting and management to avoid impending crises.