A randomized control trial of stress management for caregivers of stem cell transplant patients: Effect on patient quality of life and caregiver distress

Abstract

Background Psychological interventions reduce caregiver distress (CG‐distress). Less distress in caregivers may contribute to improved patient quality of life (QoL), but empirical evidence is lacking. Will a caregiver stress management intervention improve patient QoL? Methods In this replication study, we randomized 155 allogeneic hematopoietic stem cell transplant (Allo‐HSCT) patients and caregivers to PsychoEducation, Paced Respiration, and Relaxation (PEPRR) or enhanced treatment as usual (eTAU). We provided PEPRR over 3 months following transplant. Functional Assessment of Cancer Therapy–Bone Marrow Transplant (FACT‐BMT) evaluated patient QoL, and CG‐distress was based on depressive, anxious, and stress symptoms. Hierarchical linear models tested intervention, time, and interactions as fixed effects with participant as random effects. Results Patients whose caregivers received PEPRR did not differ on FACT‐BMT between baseline and 6 months (mean = +3.74; 95% CI, −3.54 to 11.02) compared with patients of caregivers in eTAU (mean = +3.16; 95% CI, −2.88 to 9.20) even though CG‐distress was decreased by PEPRR (mean = −0.23; 95% CI, −0.448 to −0.010) compared with those receiving eTAU (mean = +0.27; 95% CI, 0.033‐0.504) at 6 months. Conclusions PEPRR reduced CG‐distress without affecting their patient's FACT‐BMT score. The FACT‐BMT may not have distinguished unique psychological changes associated with their caregiver receiving PEPRR.

Multimodal psychosocial intervention for family caregivers of patients undergoing hematopoietic stem cell transplantation: A randomized clinical trial

“…Although prior caregiver interventions have shown reductions in stress and psychological distress among caregivers of HCT recipients, no studies have demonstrated improvements in caregiver-reported QOL or caregiving burden. [16][17][18] Improvements in both QOL and caregiving burden are notable because of the intense care demands of HCT recipients, the chronic nature of caregiving in this population, and the critical need to address caregiving burden as a major contributor to caregivers' moral exhaustion and morbidity. [12][13][14][15] Cancer April 15, 2020 We also have demonstrated the preliminary efficacy of BMT-CARE for improving anxiety and depression symptoms as well as caregivers' self-efficacy and coping skills with medium to large effect sizes.…”

“…Despite the prolonged caregiving process required for HCT, BMT‐CARE led to improvements in both QOL and caregiving burden with medium effect sizes. Although prior caregiver interventions have shown reductions in stress and psychological distress among caregivers of HCT recipients, no studies have demonstrated improvements in caregiver‐reported QOL or caregiving burden . Improvements in both QOL and caregiving burden are notable because of the intense care demands of HCT recipients, the chronic nature of caregiving in this population, and the critical need to address caregiving burden as a major contributor to caregivers' moral exhaustion and morbidity …”

“…We also have demonstrated the preliminary efficacy of BMT‐CARE for improving anxiety and depression symptoms as well as caregivers' self‐efficacy and coping skills with medium to large effect sizes. Prior studies of caregiver interventions have demonstrated reductions in caregivers' psychological distress . Enhancing caregivers' self‐efficacy and coping skills may be a key factor in reducing caregivers' psychological distress and their perceived caregiving burden .…”

“…Prior studies of caregiver interventions have demonstrated reductions in caregivers' psychological distress. [16][17][18]38 Enhancing caregivers' self-efficacy and coping skills may be a key factor in reducing caregivers' psychological distress and their perceived caregiving burden. [40][41][42] In fact, caregiving preparedness and self-efficacy may also lead to improvements in patient health behaviors, such as adherence to complex post-HCT medical regimens.…”

“…[12][13][14][15] Despite their substantial caregiving burden, relatively few interventions target the needs of caregivers of HCT recipients, and there are no interventions that span the transplant course by addressing the caregiving burden before, during, and immediately after HCT. 1,[12][13][14] Two studies examined the effect of problem solving and stress management interventions for caregivers of allogeneic HCT recipients after the patients' hospitalization for HCT, [16][17][18] Cancer April 15, 2020 but they did not target caregivers' needs before and during HCT (ie, when caregivers report the highest distress). 11,19 Moreover, because of the extent of the caregiving burden in this population, more comprehensive multimodal psychosocial interventions spanning the HCT course are needed to promote caregiver coping skills and improve overall QOL while reducing the burden and distress.…”