Research That Matters (January 17 - 20, 2008)

Rationale: The effects of cancer reverberate throughout the family, and families can exhibit significant variation in their ability to adapt and respond to the overall cancer experience. Family members can experience increased anxiety and depression, disruptions in social roles, and diminished physical health with an escalation of somatic complaints. Cancer generates demands and problems that impose severe levels of stress that challenge even the most well functioning family. Consequently, an imperative in cancer care has emerged to develop effective methods that enhance the problem-solving abilities of family caregivers to resolve difficulties related to the care of the patient outside the hospital during critical transition points.

Methods: Three pilot studies that focused on the emergence of problem-solving education as a critical intervention for both cancer patients and their family caregivers were completed at the Johns Hopkins Oncology Center in Baltimore, MD. The first study (n= 60) focused on a single 90-minute problem solving education session with patients with widely advanced disease and a family caregiver. Analysis of this data led to a follow-up study (n= 30) that indicated that this benefit was experienced by “more balanced families in comparison to more extreme families” in terms of family functioning. In this second study, the “dose of the intervention” was increased to three sessions in an effort to determine if an increased dose would lead to acceptable outcomes for “more extreme family types.” In the third pilot study (n= 12), a specific format was designed for African American cancer survivors and their caregiver where the specific problem as depression. All three studies utilized a quasi-experimental “time series” design and the primary measures were the Brief Symptom Inventory-18 (BSI-18), the Social Problem-Solving Inventory (SPSI), and the Satisfaction with Life Domains Scale (SLDS).

Results: Outcomes in the first study indicated that 70% of these caregivers derived a significant benefit from this brief intervention evidenced by a greater sense of confidence and competence related to caregiving. Only 6% did not feel confident to provide care while 83% stated that the “problem-solving manual” made a significant difference to them. 65% reported improved problem-solving skills and problem-solving scores were significantly higher at post-education evaluation. In the second study, while there was an immediate benefit associated with a higher number of sessions, the effect was not maintained at 6 months post-intervention. Finally, mean depression scores on the Brief Symptom Inventory-18 decreased by 2.5 points and mean quality of life scores increased by 6 points at 1-month post intervention. Qualitative outcomes indicate a lower level of stigma, a positive response to the educational format, and greater confidence to manage problems associated with their illness.

Implications: These pilot studies suggest that “problem-solving education” is an acceptable and effective intervention that can be provided to cancer patients and their caregivers. Moreover, this data suggests that all cancer patients and their family caregivers may benefit from this intervention, although the “dose” of the intervention requires further investigation.