Harvey-Knowles, J., Sanders, E., Ko, L., Manusov, V., & Yi, J. (2017). The impact of written emotional disclosure on cancer caregivers' perceptions of burden, stress, and depression: A randomized controlled trial. Health Communication, 33, 824–832.

To investigate whether emotional disclosure improved the well-being of caregivers who care for a spouse who experienced HSCT within the past 1 to 3 years.

Two forms of expressive writing (expressive disclosure [ED] and benefit finding [BF]) versus control (time management). Participants in the ED (prompted to discuss undisclosed thoughts/feelings related to the cancer experience) and BF (prompted to discuss any positive outcomes to the cancer experience) were emailed the same prompts three times, seven days apart. Control group received three slightly different prompts, seven days apart; the prompts asked controls to focus on activities done in past week, past 24 hours, and planned activities for the upcoming week.

• N = 64   
• AGE: 56 years
• MALES: 12.5%  
• FEMALES: 87.5%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: HSCT in the past three years
• OTHER KEY SAMPLE CHARACTERISTICS: The majority were Caucasian (92%); in a long-term relationship (average 28 years); patients were cared for at a comprehensive cancer center

• SITE: Single site   
• SETTING TYPE: Other: caregivers were reached by mail
• LOCATION: Fred Hutchinson Cancer Research Center Database of HSCT survivors in Seattle, WA

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Elder care

Randomized control trial with two intervention groups and one control.

Burden: Zarit Caregiver Burden Scale; Stress: Perceived Stress Scale (PSS); Depression: the Patient Health Questionnaire (PHQ)

Burden: Writing (regardless of writing condition) significantly decreased caregivers burden scores (p < 0.01) at posttest (M = 23.19), compared to pretest (M = 25.44). No significant main effect to intervention. 

Stress: No significant reduction in caregivers stress; however, those who had higher than average baseline stress in the control group had significant reduction in their stress as compared to those in the intervention groups.

Depression: A significant main effect: a 0.24 greater reduction in post-test depression among those in the intervention than those in the control. A significant interaction effect, those with higher than average depression at baseline has a significant benefit (2.37 point reduction) from assignment to treatment condition (p < 0.05) as compared to control (0.12 point increase in depression).

Expressive writing appears to be beneficial, regardless of type, to caregivers of survivors of HSCT.

• Small sample (< 100)
• Risk of bias (sample characteristics)
• Key sample group differences that could influence results
• Findings not generalizable
• 20% rate of attrition

ED and BF writing may decrease caregivers depression. Writing, regardless of type, may improve burden and stress among caregivers of HSCT survivors. This is a feasible and relatively simple intervention to help caregivers.