Shum, N.F., Lui, Y.L., Law, W.L., & Fong, Y.T.D. (2014). A nurse-led psycho-education programme for Chinese carers of patients with colorectal cancer: Nga Fan Shum and colleagues report on a randomised controlled trial of the effectiveness of telephone support in Hong Kong. Cancer Nursing Practice, 13, 31–39. 

To evaluate the effectiveness of a nurse-led telephonic psychoeducational intervention on caregiver strain and burden

Patients were randomized to receive the study intervention or usual care. In the intervention group, caregivers received structured telephone calls at two, four, and eight weeks after hospital discharge from colorectal nurse specialists. Calls were used to identify caring problems or psychological issues, provide related information, educate caregivers according to patient needs at different stages of recovery, and provide support. A checklist for the telephone call was used, and nurses compiled field notes during the calls. These were reviewed to ensure intervention accuracy and consistency. Usual care patients received an information sheet for home care education on discharge and were provided with a telephone hotline number. Study data were collected via phone interview.

• N = 135  
• MEAN AGE = 54 (range = 19–86 years)
• MALES: 25.7%, FEMALES: 74.3%
• KEY DISEASE CHARACTERISTICS: All had colorectal cancer; 31% had colostomy; about half of the sample were to receive adjuvant chemotherapy
• OTHER KEY SAMPLE CHARACTERISTICS: The largest proportion of caregivers were wives, and the next most frequent caregivers were daughters; 13.6% had education beyond secondary school level; most had low incomes

• SITE: Single site    
• SETTING TYPE: Home  
• LOCATION: Hong Kong

• PHASE OF CARE: Multiple phases of care

Single, blinded, randomized, controlled trial

• Depression, Anxiety, and Stress (DASS) scale 
• Zarit Burden Interview (ZBI)
• World Health Organization Quality of Life (WHOQOL-BREF) measure 

Main concerns of the caregivers were dietary advice, chemotherapy advice, and the management of wounds, bowel function, and pain. Depression and anxiety declined over time in all subjects. At two and four weeks, the reduction in depression scores was greater for those in the intervention group (p = 0.013 and p < 0.001, respectively). The mean decline in anxiety scores was greater in the intervention group at two and four weeks as well (p < 0.004). Psychological health scores improved more for those in the intervention group (p < 0.007). Scores for care burden declined more for the intervention group at all follow-up periods (p < 0.001). Baseline depression and anxiety scores were mild. There were significant group-by-time effects for depression, care burden, psychological health, and social relationships.

The findings of this study demonstrated the effectiveness of this nurse-led telephonic psychoeducational intervention to reduce caregiver burden.

• Risk of bias (no appropriate attentional control condition)  
• Risk of bias (sample characteristics)
• Other limitations/explanation: Possible testing effect with repeated measures using the same study instruments; the sample was all patients with colorectal cancer, and issues and findings may not apply to other groups; initial calls were mainly focused on issues such as wound care; it is not clear what the timing of chemotherapy was in relation to the intervention

This study showed that the provision of telephonic psychoeducation for caregivers was effective in reducing caregiver burden. The intervention also may benefit in terms of symptoms of depression and anxiety. However, the initial levels of these symptoms were not indicative of a clinically significant problem, and results declined in all caregivers over time. The provision of a telephonic intervention by nurses can be an effective and practical method of providing education and support to caregivers.