Persistent fatigue affects about 40% of breast cancer survivors (Miiske et al, 2007). Since family issues, such as role shifts and poor communication, contribute significantly to stress, a family –focused component was added to a mind-body intervention that has been shown to reduce fatigue (Appling et al, 2008; Helzlsouer et al, 2007). This paper presents the results of a mixed-method evaluation of the family-focused mind-body intervention.
Patients (N=35) were randomized to a control arm (mind-body group alone) or experimental arm (mind-body group plus family-focused intervention). The group component consisted of an 8-10 session psychoeducational program. In the family-focused intervention, family members were included in two of the group sessions and they participated with the patient in family meetings with a social worker. Standardized measures of fatigue (Piper Fatigue Scale, vitality subscale of the SF-36, and visual analog scale) mental health (SF-36), and mood (visual analog scale) were collected at baseline, program completion, and 2 and 6-month follow-up. Quantitative data were analyzed using paired t-tests. The qualitative component included direct observation of group sessions, individual interviews at program completion and 8 weeks later and social worker summaries of the family sessions. Constant comparative analyses, using NVivo7 software, identified themes related to the impact of the family component of the program. Triangulation, journaling, and member checking were used to increase trustworthiness of the qualitative results.
The demographic characteristics of patients assigned to control and experimental groups did not differ significantly. Significant reductions in fatigue and increases in mental health and mood were observed for both arms of the RCT, with all gains sustained through six months, but there were no significant differences in any of the outcome measures between the two study arms. For example, in the control arm, the Piper Fatigue Scale went from a mean of 6.5 (sd=1.2) at the start of the program to 3.3 (sd=2.6) at the 6 month follow-up, a nearly 50% reduction in fatigue. For the family-focused arm, comparative scores were 6.1 (sd=1.6) and 2.0 (sd=2.3), an almost 70% reduction; however, the difference between the two arms was not statistically significant. Qualitative findings showed that survivors who participated in the family-focused program felt that their family members (1) learned that fatigue was real, (2) showed increased sensitivity and understanding (3) improved communinication and (4) provided more support for behavior change following the intervention.
Conclusion and Implications
While much appreciated, inclusion of families in a mind body intervention did not result in significant reductions in fatigue for breast cancer survivors. The qualitative component of the study provided insight into ways in which the program impacted on families of survivors. Study limitations include a small sample size, combined with a study design where the family intervention was compared to an already highly effective intervention. Future research should include larger samples and should measure impact on family members and not just cancer survivors. Further work is needed to enhance the family intervention and to identify the characteristics of families most likely to benefit.