Cancer Carepartners: Improving patients' symptom management by engaging informal caregivers

Center for Clinical Management Research, Veteran Affairs Medical Center, Ann Arbor, MI, USA. .
BMC Palliative Care (Impact Factor: 1.78). 11/2011; 10(1):21. DOI: 10.1186/1472-684X-10-21
Source: PubMed


Previous studies have found that cancer patients undergoing chemotherapy can effectively manage their own symptoms when given tailored advice. This approach, however, may challenge patients with poor performance status and/or emotional distress. Our goal is to test an automated intervention that engages a friend or family member to support a patient through chemotherapy.
We describe the design and rationale of a randomized, controlled trial to assess the efficacy of 10 weeks of web-based caregiver alerts and tailored advice for helping a patient manage symptoms related to chemotherapy. The study aims to test the primary hypothesis that patients whose caregivers receive alerts and tailored advice will report less frequent and less severe symptoms at 10 and 14 weeks when compared to patients in the control arm; similarly, they will report better physical function, fewer outpatient visits and hospitalizations related to symptoms, and greater adherence to chemotherapy. 300 patients with solid tumors undergoing chemotherapy at two Veteran Administration oncology clinics reporting any symptom at a severity of ≥4 and a willing informal caregiver will be assigned to either 10 weeks of automated telephonic symptom assessment (ATSA) alone, or 10 weeks of ATSA plus web-based notification of symptom severity and problem solving advice to their chosen caregiver. Patients and caregivers will be surveyed at intake, 10 weeks and 14 weeks. Both groups will receive standard oncology, hospice, and palliative care.
Patients undergoing chemotherapy experience many symptoms that they may be able to manage with the support of an activated caregiver. This intervention uses readily available technology to improve patient caregiver communication about symptoms and caregiver knowledge of symptom management. If successful, it could substantially improve the quality of life of veterans and their families during the stresses of chemotherapy without substantially increasing the cost of care.

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Available from: Barbara Given, Oct 26, 2014
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    • "Design Characteristics—Most studies (N=6) specified a theoretical model that grounded their approach but did not specify how theory was used in the development of intervention materials. Individual stress and coping models, which grounded one study (Silveira et al., 2011), view social support as a form of coping assistance and posit that person-, social-, and illness-related factors influence how people appraise and cope with an illness (Thoits, 1986). Self-regulation theory (Baumeister, Heatherton, & Tice, 1994; Cameron & Leventhal, 2012) grounded two studies (Diefenbach & Butz, 2004; Milne et al., 2012). "
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    ABSTRACT: Interactive health communication technologies (IHCTs) present a new opportunity and challenge for cancer control researchers who focus on couple- and family-based psychosocial interventions. In this article, the authors first present findings from a systematic review of 8 studies that used IHCTs in psychosocial interventions with cancer patients and their caregivers. Although this research area is still in its infancy, studies suggest that it is feasible to incorporate IHCTs in such interventions, that IHCTs are generally well accepted by patients and caregivers, and that the choice of technology is largely dependent on intervention target (i.e., patient, caregiver, or both) and outcomes (e.g., decision making, symptom management, lifestyle behaviors). A major research gap has been the lack of integration of Web 2.0 technologies (e.g., social media), despite the fact that social support and communication are frequently targeted components of interventions that involve cancer patients and their caregivers. Given this, the authors next present findings from a qualitative study that they conducted to describe the different needs and preferences of 13 cancer survivors and 12 caregivers with regard to social media use. Last, the authors discuss some of the opportunities and challenges of using IHCTs in psychosocial interventions for cancer patients and their caregivers and propose directions for future research.
    Full-text · Article · Jan 2015 · Journal of Health Communication

  • No preview · Article · Oct 2012 · Journal of Geriatric Oncology
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    ABSTRACT: Background: Patient self-care support via Interactive Voice Response (IVR) can improve disease management. However, little is known about the factors affecting program engagement. Methods: We compiled data on IVR program engagement for 1173 patients with: heart failure, depression, diabetes, or cancer who were followed for 28,962 person-weeks. Patients in programs for diabetes or depression (N=727) had the option of participating along with an informal caregiver who received electronic feedback based on the patient's IVR assessments. Analyses focused on factors associated with completing weekly IVR calls. Results: Patients were on average 61 years old, 37% had at most a high school education, and 48% reported incomes of ≤$30,000. Among patients given the option of participating with an informal caregiver, 65% chose to do so. Patients completed 83% of attempted IVR assessments, with rates higher for heart failure (90%) and cancer programs (90%) than for the diabetes (81%) or depression programs (71%) (P<0.001). Among patients in diabetes or depression programs, those opting to have feedback provided to an informal caregiver were more likely to complete assessments [adjusted odds ratio, 1.37; 95% confidence interval, 1.07-1.77]. Older patients had higher call completion rates, even among patients aged 75 years and older. Missed clinic appointments, prior hospitalizations, depression program participation, and poorer mental health were associated with lower completion rates. Conclusions: Patients with a variety of chronic conditions will complete IVR self-care support calls regularly. Risk factors for missed IVR calls overlap with those for missed appointments. Involvement of informal caregivers may significantly increase engagement.
    No preview · Article · Dec 2012 · Medical care
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