Preliminary Efficacy of a Peer-Delivered Psychosocial Intervention for Family Caregivers of Patients with a Life-Threatening Cancer Diagnosis

Background: Approximately 50% of advanced cancer family caregivers report moderate to severe symptoms of psychological distress. Psychosocial interventions including coping skills training, caregiver education, and/or the provision of peer support are evidence-based methods for reducing psychological distress symptoms in cancer caregivers. Combining one or more of these methods and tailoring them to caregivers’ individual preferences and needs is often more effective than focusing on one method alone. However, existing multicomponent interventions are often rigidly structured, inattentive to cultural factors, and ignore issues of equity relative to accessing care. Moreover, despite existing evidence from efficacy studies supporting the use of psychosocial interventions to improve cancer caregiver outcomes, it often remains mechanistically unclear exactly how or why these interventions work. The purpose of the current study was to conduct a randomized controlled pilot trial to determine preliminary efficacy of a 1:1 peer-delivered psychosocial intervention, Peer Caregiver Navigation (PCN), on hypothesized mechanisms of change and caregiver psychological distress outcomes.

Methods: Caregivers were recruited through a Midwestern cancer center. Caregivers randomized to the intervention group (n=45) participated in up to 5 intervention sessions with a nonprofessionally trained peer supporter. The peer supporter was a bereaved family caregiver of a person who died of cancer. Sessions included a combination of social support, psychoeducation, and coping skills coaching. Caregivers randomized to the control group (n=44) received usual care. Data were collected through 4 surveys of research participants—baseline, midpoint, post-intervention, and 30-day follow-up. Instruments on the surveys measured demographic characteristics, psychological distress, anxiety symptoms, depressive symptoms, coping techniques, emotion regulation, and self-efficacy. Hypotheses were tested using parametric and non-parametric t-tests. Researchers examined differences between the control and intervention group in measure change and their associated p-values and effect sizes.

Results: Results of hypothesis testing indicated that the intervention had preliminary efficacy (p value ≤ .05) in affecting change in anxiety, emotion regulation via cognitive reappraisal, and self-efficacy, compared to control. Additionally, other coping outcomes demonstrated potential for a clinically relevant difference given the effect size for these outcomes was moderate (d = .50) and approaching significance (p < .1).

Implications: Findings have multiple implications for social work practice at the micro, mezzo, and macro levels. Leveraging nonprofessional peer supporters to deliver psychosocial support to family caregivers of cancer patients may be an effective strategy for mitigating caregiver distress. Given the high caseloads of social workers and other mental health professionals, cost-effective, community-based interventions like PCN that are shown to be effective have important implications for expanding the mental health workforce to achieve equitable access to mental health services for minoritized and traditionally underserved caregivers. Training new and existing social work professionals in task sharing interventions creates an opportunity for the development of organizational models that elevate the role of nonprofessionals in the holistic support and care of hospice patients and their families. Accordingly, supervision and program implementation models could be developed to help support and sustain such programs and services.