Palliative Care Intervention for Caregivers of Lung Cancer Patients
|Program Title||Palliative Care Intervention for Caregivers of Lung Cancer Patients|
|Purpose||Designed to enhance the quality of life for caregivers of individuals with cancer. (2015)|
|Program Focus||Psychosocial - Coping|
|Age||Adults (40-65 years), Older Adults (65+ years), Young Adults (19-39 years)|
|Race/Ethnicity||Alaskan Native, American Indian, Asian, Black, not of Hispanic or Latino origin, Hispanic or Latino, White, not of Hispanic or Latino origin|
|Setting||Clinical, Rural, Suburban, Urban/Inner City|
|Funded by||NCI (Grant number(s): P01-CA136396)|
|User Reviews||(Be the first to write a review for this program)|
Palliative care can help improve the quality life (QOL) of FCGs of lung cancer patients, regardless of the patients’ disease stage. (Based on the size, location, and progression of the tumor, patients are assigned a stage of cancer: occult [hidden stage], Stage 0, Stage I, Stage II, Stage IIIA, Stage IIIB, and Stage IV.) Providing palliative care for caregivers aims to reduce caregiver stress, help caregivers cope with challenges, and protect their own health.
The intervention has three key components. First, a nurse meets with the FCGs (as well as the patients) to complete a comprehensive baseline assessment that includes QOL and psychological distress. This assessment is used to create a personalized palliative care plan that includes four domains of QOL: physical, psychological, social, and spiritual. Second, FCGs’ cases are presented at a weekly meeting of the interdisciplinary team (IDT), which includes nurses, palliative medicine physicians, thoracic surgeons, medical oncologists, a geriatric oncologist, a pulmonologist, a social worker, a chaplain, a dietitian, and a physical therapist. Using the comprehensive QOL assessment as a guide, the IDT makes recommendations for supportive care referrals and community resources. Last, FCGs receive four nurse-led, one-on-one educational sessions addressing self-care and the QOL domains. The sessions are tailored to individual caregivers in that caregivers select the session topics to discuss from a list of options. Caregivers receive an educational manual containing information on all the QOL domains. During these sessions, the nurse also discusses the supportive care resources the IDT recommended.
The nurses who complete the baseline assessments and educational sessions have at least 20 years of experience in oncology. Palliative Care Intervention for Caregivers of Lung Cancer Patients is designed to be implemented in conjunction with Palliative Care Intervention for Lung Cancer Patients. The patient intervention aims to improve symptom management and quality of life for lung cancer patients.
The Implementation Guide is a resource for implementing this program. It provides important information about the staffing and functions necessary for administering this program in the user's setting. Additionally, the steps needed to carry out the research-tested program, relevant program materials, and information for evaluating the program are included. The Implementation Guide can be viewed and downloaded in the Products page.
-- Approximately 20–30 minutes for completing the baseline assessment
-- Approximately 15 minutes per FCG for presentation at one IDT meeting
-- Approximately 30 minutes for each education session
--Palliative Care for Family Caregivers of Patients Living With Lung Cancer [caregiver manual]
--PC1 Interdisciplinary Care Plan
For costs associated with this program, please contact the developer, Betty Ferrell. (See products page on the RTIPs website for developer contact information.)
About the Study
Of the 366 FCGs who completed the baseline assessment, 38% were men and 62% were women. Seventy-seven percent of the participants were White, 11% were Asian, 3% were Black or African American, 3% were Native Hawaiian/other Pacific Islander, less than 1% were American Indian/Alaska Native, and 5% were “Other.” For more than half of FCGs, 79%, were married or had partners, 13% were single, and 8% were separated, widowed, or divorced. And for more than half of FCGs, 59%, made more than $50,000 per year, 21% of participants made less, and 20% preferred not to answer.
Significant baseline differences existed between the study groups on the variables of work hours and race/ethnicity.
The study’s primary outcomes were caregiver quality of life, psychological distress, and caregiver burden. Outcomes were measured using the following instruments:
-- QOL domains were measured with the FCG version of the City of Hope QOL Tool (COH-QOL-FCG). This assessment has 37 items addressing physical, psychological, social, and spiritual domains. The total score in each domain ranges from 0 to 10, with higher scores representing better QOL.
-- Psychological distress was measured with the Distress Thermometer (DT). The total score ranges from 0 to 10, with higher scores representing more distress.
-- Caregiver burden was measured with the 14-item Montgomery Caregiver Burden Scale. This assessment measures three dimensions of burden: objective burden, subjective demand, and subjective stress. The total score ranges from 6 to 30 for objective burden, from 4 to 20 for subjective demand, and from 4 to 20 for subjective stress, with higher scores representing higher burden. The study assessed the percentage of intervention and usual care participants reporting “quite high” caregiver burden.
Data were collected using these instruments at baseline and 7 and 12 weeks. The data used in the primary analyses were collected at the 12-week follow-up.
- At 12-week follow-up, FCGs in the intervention group had better QOL in the social well-being domain in comparison with those in the usual care group across disease stages (p<.001).
- At 12-week follow-up, FCGs in the usual care group had greater psychological distress in comparison with those in the intervention group across disease stages (p=.01).
- At 12-week follow-up, a smaller percentage of intervention group participants than usual care group participants reported an elevated objective burden (16% vs. 33%; p<.001) and elevated subjective stress (13% vs. 24%; p=.008).
- Within the QOL domains assessed, no significant differences were found between the intervention and usual care groups in the physical and psychological domains. In the spiritual domain, the usual care group had significantly higher spiritual well-being than the intervention group at follow-up (p=.043).
- Within the assessments of burden, no significant differences were found between the intervention and usual care groups on subjective demand.
Sun V, Grant M, Koczywas M, Freeman B, Zachariah F, Fujinami R, Ferraro CD, Uman G, Ferrell B. (2015). Effectiveness of an interdisciplinary palliative care intervention for family caregivers in lung cancer. Cancer, 121 (20), 3737-3745.
Ferrell B, Sun V, Hurria A, Cristea M, Raz DJ, Kim JY, Reckamp K, Williams AC, Borneman T, Uman G, Koczywas M. (2015). Interdisciplinary Palliative Care for Patients With Lung Cancer. Journal of Pain and Symptom Management, 50 (6), 758-767.
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