A Randomized Control Trial of a Multifamily Group Psychoeducation Model for Hepatitis C

Background

Approximately 4 million Americans are chronically infected with the hepatitis C virus (HCV).  A relatively recent review found that only a small minority of HCV patients presenting for health care are treatment-eligible and advance to treatment; even fewer complete treatment, and only about 5% achieve sustained virologic response.  It has been suggested that psychosocial group interventions have the potential improve medical and psychosocial outcomes for patients with HCV and their families and other informal caregivers.  Patient education, including education in groups, is a routine part of many HCV practices.  However, efforts to include families in HCV education have just begun.  A multifamily psychoeducation group program successfully applied in populations with serious mental illness was translated to address the specific needs of patients with Hepatitis C (HCV) and tested in a randomized controlled trial compared with a didactic education group intervention of equivalent intensity.

Methods

309 patients considering treatment for HCV (monoinfected and coinfected with HIV) were recruited and randomized to HCV-PERF (PsychoEducation Responsive to Families coping with HCV; n=186) and comparison condition (n=123) in three sites, two liver clinics associated with academic medical centers and an HCV clinic attached to a Veteran’s Administration Medical Center. HCV-PERF groups met for 90 minutes twice monthly for 6 months, and were co-facilitated by a medical and a mental-health professional (Social Worker).  Group meetings included a didactic presentation specific to a topic selected by group members, followed by discussions.  Members randomized to the comparison condition were given didactic materials related to HCV issues at a similar dosage.  Participants were interviewed for demographic, medical, and psychosocial outcomes at recruitment, and followed up at 12 (6 months post-intervention) and 24 months.

Results

Significant improvements were found in both conditions for alcohol, drug use, and quality of life at both follow-ups, depression at first follow-up, and treatment satisfaction at second follow-up.  In spite of these improvements (similar to other psychosocial interventions), participants reported limited access to services and infrequent sustained virologic response.  No significant differences were observed between conditions. 

Discussion

Although the study did not identify a unique contribution of HCV-PERF, it suggested the potential for education group models as part of overall treatment. Lack of differences between conditions may be attributable to group dynamics or the desire of participants in both conditions to provide support.  As HCV treatment further improves, interventions like HCV-PERF become more essential for achieving successful outcomes.  Interventions such as HCV-PERF represent ideal roles for psychiatric social workers as part of treatment teams for medical conditions.