Effectiveness Not Established

Psychoeducation/Psychoeducational Interventions

for Cognitive Impairment

Psychoeducation or psychoeducational interventions encompass a broad range of activities that combine education and other activities such as counseling and supportive interventions. Psychoeducational interventions may be delivered individually or in groups, and may be tailored or standardized. This type of intervention generally includes providing patients with information about treatments, symptoms, resources and services, training to provide care and respond to disease-related problems, and problem-solving strategies for coping with cancer. Interventions may include use of booklets, videos, audiotapes, and computers, and formats may be interactive between healthcare professionals and patients and caregivers, self-directed via use of CDs and other materials, online, or delivered telephonically. Studies using psychoeducational interventions tend to vary substantially in specific content, format, frequency, and timing of the interventions. For this reason, there is limited ability to currently examine the relative effectiveness of different formats and delivery methods. Highly specific content approaches, such as mindfulness-based stress reduction and cognitive behavioral approaches, are identified in these resources as separate interventions, rather than incorporated into overall psychoeducation.

 

Research Evidence Summaries

Bernstein, L.J., McCreath, G.A., Nyhof-Young, J., Dissanayake, D., & Rich, J.B. (2018). A brief psychoeducational intervention improves memory contentment in breast cancer survivors with cognitive concerns: Results of a single-arm prospective study. Supportive Care in Cancer, 26, 2851–2859.

Study Purpose

To assess the impact of a brief, individualized, psychoeducational intervention on the self-management of cancer-related cognitive dysfunction (CRCD) for survivors of breast cancer. Primary endpoint: memory contentment; secondary endpoints: knowledge, attitudes, and behaviors related to CRCD.

Intervention Characteristics/Basic Study Process

Participants received a one-hour individualized psychoeducational intervention delivered by a clinical neuropsychologist that was tailored specifically to their level of knowledge and specific complaints related to CRCD. Content included information on CRCD, strategies to reduce frustration and normalize the experience, as well as specific strategies to improve memory. Strategies were not practiced during the session; however, participants selected one or two specific goals to regularly practice between assessment timepoints.

Sample Characteristics

  • N = 100   
  • AGE: 18 or older, mean age = 52.19 (range = 35-79)
  • FEMALES: 100%
  • CURRENT TREATMENT: Chemotherapy, radiation, combination radiation and chemotherapy, immunotherapy, and other
  • KEY DISEASE CHARACTERISTICS: Female patients diagnosed with breast cancer, not restricted by stage of disease, previous or current treatment. The majority had stage I or II disease and had completed chemotherapy and/or radiation. Half were currently receiving endocrine therapy. 
  • OTHER KEY SAMPLE CHARACTERISTICS: The majority were well educated at the college level or above and were currently employed.

Setting

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: Princess Margaret Cancer Center

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Study Design

Single-arm, prospective, longitudinal study

Measurement Instruments/Methods

  • Multifactorial Memory Questionnaire (MMQ)--contentment subscale
  • Researcher-developed instrument to measure CRCD knowledge (2 items), symptom distress (2 items), self-efficacy for CRCD management (3 items), satisfaction with the intervention (2 items), and effectiveness of compensatory strategies (3 items)

Results

Memory contentment improved from T1 to T2 (p < 0.001, Cohen’s d = 0.58) and T1 to T3 (p < 0.001, d = 0.77). 

Reliable Change Index (RCI) indicated statistically reliable change for 32% following the intervention. Reliable change was durable at six weeks postintervention for 38%. 

Participants’ statistically significant improvement in memory contentment after the intervention remained lower than published norms at six weeks follow-up (p < 0.001, d = -0.93). 

Lower baseline memory contentment predicted increased improvement postintervention (T1-T2: b = -0.18, p = 0.004; T1-T3: b = -0.18, p = -0.023). Change in memory contentment from baseline to six weeks postintervention was positively associated with compensatory strategy effectiveness (b = 3.73, p = 0.011).

Conclusions

The researchers concluded that the brief one-hour, individualized psychoeducational intervention appeared to be effective and durable in relieving distress from CRCD and improving memory contentment and self-efficacy for managing CRCD. They also concluded that the results supported generalizability of the intervention effectiveness to survivors currently on treatment.

Limitations

  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Risk of bias (no appropriate attentional control condition)
  • Subject withdrawals ≥ 10%
  • Other limitations/explanation: Subjective measures only

Nursing Implications

Individually tailored psychoeducational interventions for CRCD may be efficacious for facilitating self-efficacy in coping strategies and improvement of memory contentment for survivors of breast cancer. Future study with a randomized controlled design is needed for further validation and investigation of the intervention.

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