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.doi:10.1007/s00520-011-1295-5
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.
Active antitumor treatment phase
A randomized controlled trial design was used.
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.