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Mabel Leow, BSc (Hons), Sally Chan, PhD, MSc, BSc, RN, FAAN,
and Moon Fai Chan, PhD, CStat
F
amily members are expected to take on
the responsibilities of caring for their sick Purpose/Objectives: To evaluate the effectiveness of a psy-
choeducational intervention, the Caring for the Caregiver
relatives in Asian societies, such as Singa- Programme (CCP).
pore, that highly value filial piety (Chow,
Design: A pilot randomized, controlled trial, two-group
2009). However, caring for a person with pretest, and repeated post-tests.
advanced cancer is physically and emotionally chal-
Setting: Four home hospice organizations and an outpatient
lenging. Physically, the person with advanced cancer clinic in Singapore.
has complex needs and requires extensive care from
Sample: 80 caregivers were randomized into experimental
the caregiver. Emotionally, the caregiver has to deal and standard care groups.
with the patients impending death (Tsigaroppoulos et
Methods: Outcomes were measured at baseline, week 4,
al., 2009). Caregivers may experience significant stress, and week 8 after the intervention. The standard care group
and some suffer from depression and decreased quality received routine home hospice care, and the intervention
of life (QOL) (Hudson, Thomas, Trauer, Remedios, & group received the CCP in addition to routine care.
Clarke, 2011). Main Research Variables: Quality of life (QOL), social
The World Health Organization ([WHO], 1996) has support, stress and depression, self-efficacy in self-care,
defined QOL as individuals perceptions of their closeness with the patient, rewards, and knowledge.
position in life in the context of the culture and value Findings: Compared to the standard care group, the in-
systems in which they live and in relation to their goals, tervention group reported significantly higher QOL, social
support satisfaction and number of supported people,
expectations, standards, and concerns (p. 5). In end- closeness with the patient, self-efficacy in self-care, re-
of-life care, QOL is one of the key indicators for service wards of caregiving, and knowledge, and lower stress and
evaluation (WHO, 2015). Therefore, interventions depression.
should be targeted at improving caregivers QOL. Conclusions: The CCP had positive effects on family
Generally, the literature supports psychoeducational caregivers of patients with advanced cancer.
interventions for improving caregivers QOL (Harding Implications for Nursing: A psychoeducational inter-
& Higginson, 2003; Hudson, Remedios, & Thomas, vention potentially could help caregivers cope with the
2010). However, several knowledge gaps were identi- demands of caregiving.
fied (Harding & Higginson, 2003; Hudson et al., 2010). Key Words: family caregivers; home hospice care; psycho-
Harding and Higginson (2003) commented on the lack educational intervention; palliative care
of rigorous design in many reviewed studies with ONF, 42(2), E63E72. doi: 10.1188/15.ONF.E63-E72
small sample sizes. A review by Hudson et al. (2010)
reported that, despite an increase in the quality and
quantity of intervention studies, psychosocial support
for caregivers in palliative care was still in its early caregivers (Leow, Chan, & Chan, 2014). Caregivers
stages. In the Singapore context, to the best of the re- QOL remained constant over a period of two months
searchers knowledge, no study on psychoeducational without any intervention, and social support satisfac-
interventions for caregivers of a person with advanced tion was essential in improving caregivers QOL. In
cancer has been conducted. addition to requiring help to cope with stress and nega-
Prior to the current study, the researchers conducted tive emotions (Funk et al., 2010), the literature also sug-
a study to understand the QOL and experiences of gested that caregivers need information and improved
random number table, generated by the researchers consistency, one nurse researcher delivered the CCP to
from a Microsoft Excel spreadsheet, was used to al- all participants in the intervention group.
locate participants into their respective groups. After Banduras (1985) self-efficacy theory guided the
participants signed the consent form, they were allo- development of the CCP. The CCP aimed to help
cated to the standard care or intervention group based caregivers cope with stress, frustration, depression, and
on the random number table. anticipatory grief; improve communication between
Participants in the standard care group received rou- patients and caregivers; increase social support for
tine care from their respective home hospice organiza- caregivers; and provide caregivers with information
tion, which included regular weekly to monthly visits on advanced care planning and community resources.
(about 30 minutes) from a home hospice nurse. The The researchers expected this to result in an increase in
nurse also may have provided psychosocial support, caregivers QOL because they would be better able to
such as counseling, if required by the caregiver. cope with caregiving (see Figure 1).
The CCP consisted of a one-hour face-to-face ses-
Pyschoeducational Intervention sion, a video clip, two follow-up phone calls, and
The intervention group received the CCP in addi- an invitation to an online social support group. An
tion to routine care. One palliative care doctor, two intervention protocol was used to guide intervention
palliative care nurses, and three former caregivers of a delivery. The initial face-to-face session was delivered
patient in home hospice care also were invited to vali- within one week of obtaining baseline measures. Dur-
date the CCP prior to its commencement. To maintain ing the face-to-face session, the caregivers viewed the
Age (years) 47.31 11.94 2272 47.00 11.73 2268 47.16 11.76 2272 0.12 0.91
Caregiving duration (months) 09.78 22.21 0144 09.22 15.68 078 09.52 19.27 0144 0.13 0.90
Characteristic n n n c2 p
20-minute video and developed a care plan with the achieve self-instructed performance (e.g., coping with
nurse researcher to enable the intervention to be tai- stress), the caregivers were provided with knowledge
lored to their individual needs. The discussion of the on the subject (e.g., signs of stress) in the video so that
care plan required about 40 minutes. At the end of the they would be aware that they were experiencing
session, caregivers email addresses were obtained and stress. Strategies to reduce stress (e.g., listening to mu-
they were invited to a caregiver forum. sic) were suggested in the video and discussed during
The nurse researcher made two follow-up phone calls the development of the care plan to ensure that they
at weeks 3 and 6. During the calls, the nurse researcher could be employed and the goals could be achieved.
reviewed the care plan with the caregiver, encouraged To achieve vicarious experience, the video that featured
the caregiver to engage in self-care activities and focus a caregiver and patient with advanced cancer was
on the positive gains of caregiving, and provided sup- provided. Studies have found that modeling is more
port. The session was guided by a protocol, and the effective when the models in the video are similar to the
duration varied from 1530 minutes, according to the targeted audience (Bandura, 1985; Clark & Lester, 2000).
individual caregivers needs. The aims and content of The video addressed issues faced by caregivers and
the teaching session are in Figure 2. strategies used to cope with them. Verbal persuasion to
Banduras (1985) four strategiespersonal mastery, participate in self-care activities and seek social support
vicarious experiences, verbal persuasion, and physi- was provided using suggestions and exhortation dur-
ologic feedbackwere adopted. To achieve personal ing the face-to-face session, follow-up phone calls, and
mastery, self-instructed performance was used. To online forum. Physiologic feedback was enhanced by
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