Tuesday, March 21, 2006
Cancer has published an interesting trial of a coping skills intervention for family caregivers of hospice patients. It is a randomized trial involving ~350 family caregivers of cancer patients who were receiving hospice services. The subjects were randomized to usual care, non-specific support visits, and a structured coping-skills intervention. This is the authors' description of the structured intervention ("COPE"):
This coping intervention derives from the conceptual and research literature on problem solving training and therapy. The Family COPE model adapts these concepts to address the specific needs of families caring for persons with cancer at home. The model has four components: Creativity (viewing problems from different perspectives to develop new strategies for solving caregiving problems, e.g., "What could I do to distract Dad from his pain?"); Optimism (having a positive, but realistic, attitude toward the problem-solving process, e.g., "I believe I can help Dad with his pain."). This includes communicating realistic optimism to the patient by showing both understanding and hope and involves patients, as much as possible, in planning; Planning (setting reasonable caregiving goals and thinking out, in advance, the steps necessary to reach those goals, e.g., "How can I get Dad ready for our family holiday party?"); and Expert information (what nonprofessionals need to know about the nature of the problem, when to get professional help, and what family caregivers can do on their own to deal with the problem, e.g., "Where can I go to get help with Dad's pain?").
Basically, the subjects in the COPE arm of the trial had improved quality of life, as well as less of a sense of 'burden.'
A few things about this. First, this is a heartening trial to see--a well designed, randomized trial with reasonable control groups (the two controls--both a usual care group and a non-specific support group who received the same amount of time in support as the COPE group did) in a hospice population (well, at least a hospice caregiver population). The trouble with these trials for me is that they use a wide variety of measurement instruments (quality of life, etc.)--half of which I've never heard of--and although the results are legit--the COPE intervention produced measurable and significant results--I don't have any sense of the magnitude of the benefit. Was it big enough that this is some great thing which should be offered to everyone, or were the benefits relatively modest and not necessarily worth the cost outside of a trial, etc? Hopefully this will be answered with future trials. It definitely gives boost to a growing area of interest in supportive cancer care/palliative care--family caregiver well-being (see related posts here & here & here).