Psychosocial Intervention for Caregivers May Improve Quality of Life

A brief, multimodal psychosocial intervention for caregivers of patients undergoing hematopoietic stem cell transplantation (HCT) could improve their quality of life (QOL), caregiving burden and anxiety and depression symptoms, as well as their self-efficacy and coping skills, according to study findings published in Cancer.

“Before HCT, caregivers experience immense psychological distress as they prepare for their loved ones’ hospitalization for HCT and cope with the uncertainty of the patients’ prognosis,” the researchers explained. “During HCT, caregivers’ distress remains elevated as their loved ones receive high-dose chemotherapy associated with multiple toxicities, physical symptoms and a prolonged hospitalization. Finally, in the months after HCT, caregivers manage ongoing physical symptoms, attend multiple outpatient appointments, and navigate complex medication schedules while coping with the uncertainty of the illness.”

As a result, this burden negatively affects their quality of life, highlighting a need for intervention.

Therefore, the researchers conducted a an unblinded, randomized trial of a psychosocial intervention (BMT-CARE) for caregivers of patients who are undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomized to receive either usual care plus BMT-CARE — which was a tailored intervention aligned with the HCT trajectory, integrating treatment-related education and self-care with cognitive-behavioral skills to promote coping — or just usual care.

“Skills are uniquely tailored to expected challenges along the transplant continuum and include the following essential components: education to address preparedness, manage expectations, and develop caregiving skills such as symptom and medication management, mobilization of social supports, and assessment of post-discharge needs during the HCT course; cognitive-behavioral skills—based strategies to facilitate effective coping, cognitive reframing, mindfulness, communication, and acceptance while one is living with uncertainty; and behavioral strategies for self-care to promote caregiver physical and mental health,” the researchers explained.

They aimed to determine the feasibility of the intervention, which the researchers defined as at least 60% of eligible caregivers enrolling in it and completing 50% or more of the intervention sessions. In addition, they assessed caregiver QOL, burden, psychological distress, self-efficacy and coping measures at baseline, as well as 30 and 60 days after their loved one underwent HCT.

Usual care includes meetings with the transplant social worker once before HCT to address any issues or concerns. With BMT-CARE, caregivers met with a psychologist or social worker either in person, by telephone or through a video conference for six sessions (four weekly and two semimonthly individual sessions, lasting approximately one hour each).

“Importantly, approximately half of the BMT-CARE intervention sessions took place over the telephone or via video conferencing, which allows for a more scalable and potentially disseminable intervention delivery model,” the researchers noted.

In addition, each caregiver was given a BMT-CARE workbook that included in-session and at-home practice exercises to facilitate learning and skill acquisition. The first session started before HCT and continued up to 60 days after transplantation.

Of the 100 eligible caregivers enrolled, 80% attended at least half, if not more, of the intervention sessions.

Caregivers who were randomized to BMT-CARE reported having improved QOL, caregiving burden, lower anxiety and depression symptoms, and improved self-efficacy and coping skills compared with caregivers in the usual-care group.

“These encouraging findings warrant further testing in a multisite, randomized clinical trial,” the researchers concluded. "... Future studies to examine the effect of BMT-CARE on patient outcomes and to explore potential mediators of the intervention effects on caregivers’ psychological distress and caregiving burden are warranted.”