Randomized clinical trial of a brief and extensive dyadic intervention for advanced cancer patients and their family caregivers

Psycho-Oncology - Tập 22 Số 3 - Trang 555-563 - 2013
Laurel Northouse1, Darlene Mood2, Ann Schafenacker1, Gregory P. Kalemkerian3, Mark M. Zalupski3, Patricia LoRusso4, Daniel F. Hayes3, Maha Hussain3, John Ruckdeschel5, A. Mark Fendrick3, Peter C. Trask6, David L. Ronis1,7, Trace Kershaw8
1School of Nursing, University of Michigan, Ann Arbor, MI, USA
2College of Nursing, Wayne State University, Detroit, MI USA
3Internal Medicine, University of Michigan, Ann Arbor, MI, USA
4Medical Oncology Karmanos Cancer Center Detroit MI USA
5School of Medicine University of Nevada Las Vegas NV USA
6Sanofi Aventis, Cambridge, MA, USA
7VA Center for Clinical Management Research, Ann Arbor, MI, USA
8School of Public Health, Yale University, New Haven, CT, USA

Tóm tắt

AbstractBackgroundFew intervention programs assist patients and their family caregivers to manage advanced cancer and maintain their quality of life (QOL). This study examined (i) whether patient–caregiver dyads (i.e., pairs) randomly assigned to a brief or extensive dyadic intervention (the FOCUS Program) had better outcomes than dyads randomly assigned to usual care and (ii) whether patients' risk for distress and other factors moderated the effect of the brief or extensive program on outcomes.MethodsAdvanced cancer patients and their caregivers (N = 484 dyads) were stratified by patients' baseline risk for distress (high versus low), cancer type (lung, colorectal, breast, or prostate), and research site and then randomly assigned to a brief (three‐session) or extensive (six‐session) intervention or control. The interventions offered dyads information and support. Intermediary outcomes were appraisals (i.e., appraisal of illness/caregiving, uncertainty, and hopelessness) and resources (i.e., coping, interpersonal relationships, and self‐efficacy). The primary outcome was QOL. Data were collected prior to intervention and post‐intervention (3 and 6 months from baseline). The final sample was 302 dyads. Repeated measures MANCOVA was used to evaluate outcomes.ResultsSignificant group by time interactions showed that there was an improvement in dyads' coping (p < 0.05), self‐efficacy (p < 0.05), and social QOL (p < 0.01) and in caregivers' emotional QOL (p < 0.05). Effects varied by intervention dose. Most effects were found at 3 months only. Risk for distress accounted for very few moderation effects.ConclusionsBoth brief and extensive programs had positive outcomes for patient–caregiver dyads, but few sustained effects. Patient–caregiver dyads benefit when viewed as the ‘unit of care’. Copyright © 2012 John Wiley & Sons, Ltd.

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Psycho-Oncology

Tập 22 Số 3

555-563

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