The authors of the COPE study contend that their model moderates caregiver stress through empowerment and training.
Skills training for caregivers has proven effective in improving their quality of life, reducing the burden associated with symptom management, and in strengthening caregiving tasks. Such programs are effective for caregivers of patients at all stages of cancer, including end-of-life care and hospice. The most effective skills training programs tend to be nursing intervention programs, which combine guidance, support, and nursing home visits. Nurse-led transition coaching programs prepare patients and caregivers for the next level of care, teach communication skills, and follow patients to the home. In addition, the nurses initiate phone calls at 2, 7, and 14 days after discharge, thereby providing continuity of care through a single point of contact.
The effectiveness of psychoeducational programs for caregivers of cancer patients has been mixed. For example, a 6-week problem-solving intervention with spouses of cancer patients was successful at reducing depression; however, there were no effects on coping, social support, or psychological well-being. In another study, 237 cancer patient/caregiver dyads were randomly assigned to one of two groups: a conventional care group or a 20-week experimental group. The focus of the intervention was improving the caregiver's ability in symptom management and reducing their distress. Although the intervention improved caregivers' symptom management abilities, it was not effective in decreasing their depression.
It is possible that interventions with multiple components are more effective in assisting caregivers. For example, the Family Caregiver Cancer Education Program targets education about symptom management along with skill-building in communication, managing roles and relationships, managing finances, and maintaining self-care. Caregivers' sense of confidence and being well informed increased after participation in the program, while perceptions of their own health improved over time.
The Family Meeting
Refer to the Convening a Family Meeting section in the Physicians Interacting With Family Caregivers section of this summary for more information.
Rehabilitation for the Caregiver
Although the subject of caregiver burden is well represented in the literature, one comprehensive review found a strikingly limited number of studies addressing interventions for caregiver strain and burden in oncology. The extensive literature search yielded only 20 intervention studies, with only 8 studies that specifically cited outcome measures for strain and burden. Two systematic reviews [13,26] exclusively examined studies of caregivers in oncology or palliative care populations. However, most study designs were qualitative, descriptive, cross-sectional, or nonexperimental designs; therefore, many of the proposed interventions for caregivers (e.g., competence, support, respite, or adult day care) are those whose effectiveness cannot be established until further evidence is obtained with randomized clinical trials.
Despite the fact that some of the interventions studied had positive psychosocial outcomes, the studies could not document a reduction in caregiver burden. Therefore, those particular strategies require further testing before their effectiveness in reducing caregiver burden can be established.