Cancer Carepartners: Improving patients' symptom management by engaging informal caregivers

<p>Abstract</p> <p>Background</p> <p>Previous studies have found that cancer patients undergoing chemotherapy can effectively manage their own symptoms when given tailored advice. This approach, however, may challenge patients with poor performance status and/or emotional distress. Our goal is to test an automated intervention that engages a friend or family member to support a patient through chemotherapy.</p> <p>Methods/Design</p> <p>We describe the design and rationale of a randomized, controlled trial to assess the efficacy of 10 weeks of web-based caregiver alerts and tailored advice for helping a patient manage symptoms related to chemotherapy. The study aims to test the primary hypothesis that patients whose caregivers receive alerts and tailored advice will report less frequent and less severe symptoms at 10 and 14 weeks when compared to patients in the control arm; similarly, they will report better physical function, fewer outpatient visits and hospitalizations related to symptoms, and greater adherence to chemotherapy. 300 patients with solid tumors undergoing chemotherapy at two Veteran Administration oncology clinics reporting any symptom at a severity of ≥4 and a willing informal caregiver will be assigned to either 10 weeks of automated telephonic symptom assessment (ATSA) alone, or 10 weeks of ATSA plus web-based notification of symptom severity and problem solving advice to their chosen caregiver. Patients and caregivers will be surveyed at intake, 10 weeks and 14 weeks. Both groups will receive standard oncology, hospice, and palliative care.</p> <p>Discussion</p> <p>Patients undergoing chemotherapy experience many symptoms that they may be able to manage with the support of an activated caregiver. This intervention uses readily available technology to improve patient caregiver communication about symptoms and caregiver knowledge of symptom management. If successful, it could substantially improve the quality of life of veterans and their families during the stresses of chemotherapy without substantially increasing the cost of care.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00983892">NCT00983892</a></p

Husbands&rsquo; perceptions of their wives&rsquo; breast cancer coping efficacy: testing congruence models of adjustment

Thomas V Merluzzi,1 MaryAnn Martinez Sanchez2 1Department of Psychology, University of Notre Dame, Notre Dame, IN, 2Pima Community College, Tucson, AZ, USA Introduction: Recent reviews have reinforced the notion that having a supportive spouse can help with the process of coping with and adjusting to cancer. Congruence between spouses&rsquo; perspectives has been proposed as one mechanism in that process, yet alternative models of congruence have not been examined closely. This study assessed alternative models of congruence in perceptions of coping and their mediating effects on adjustment to breast cancer.Methods: Seventy-two women in treatment for breast cancer and their husbands completed measures of marital adjustment, self-efficacy for coping, and adjustment to cancer. Karnofsky Performance Status was obtained from medical records. Wives completed a measure of self-efficacy for coping (wives&rsquo; ratings of self-efficacy for coping [WSEC]) and husbands completed a measure of self-efficacy for coping (husbands&rsquo; ratings of wives&rsquo; self-efficacy for coping [HSEC]) based on their perceptions of their wives&rsquo; coping efficacy.Results: Interestingly, the correlation between WSEC and HSEC was only 0.207; thus, they are relatively independent perspectives. The following three models were tested to determine the nature of the relationship between WSEC and HSEC: discrepancy model (WSEC&nbsp;-&nbsp;HSEC), additive model (WSEC&nbsp;+&nbsp;HSEC), and multiplicative model (WSEC&nbsp;&times;&nbsp;HSEC). The discrepancy model was not related to wives&rsquo; adjustment; however, the additive (B=0.205, P&lt;0.001) and multiplicative (B=0.001, P&lt;0.001) models were significantly related to wives&rsquo; adjustment. Also, the additive model mediated the relationship between performance status and adjustment.Discussion: Husbands&rsquo; perception of their wives&rsquo; coping efficacy contributed marginally to their wives&rsquo; adjustment, and the combination of WSEC and HSEC mediated the relationship between functional status and wives&rsquo; adjustment, thus positively impacting wives&rsquo; adjustment to cancer. Future research is needed to determine the quality of the differences between HSEC and WSEC in order to develop interventions to optimize the impact of these two relatively independent perspectives on cancer outcomes. Keywords: couples, cancer, coping, adjustment, self-efficac