Enhanced coping and self‐efficacy in caregivers of stem cell transplant recipients: Identifying mechanisms of a multimodal psychosocial intervention

Autor: Lara Traeger, Joseph A. Greer, Ashley M. Nelson, Annemarie D. Jagielo, Jennifer S. Temel, Jamie M. Jacobs, Jennifer D'Alotto, Lauren Waldman, Showly Nicholson, Areej El-Jawahri
Rok vydání: 2020
Předmět:
Zdroj: Cancer
ISSN: 1097-0142
0008-543X
Popis: BACKGROUND: In a recent trial, a six-session intervention (BMT-CARE) that integrated medical information with cognitive-behavioral strategies improved quality of life (QOL), mood, coping skills, and self-efficacy in family/friend caregivers of hematopoietic stem cell transplantation (HCT) recipients. We examined whether improvements in coping and self-efficacy mediated the intervention effects on QOL and mood. METHODS: From 12/2017 to 4/2019, we enrolled 100 caregivers of HCT recipients in a randomized clinical trial of BMT-CARE versus usual care. Caregivers completed self-report measures of QOL (CareGiver Oncology QOL questionnaire), depression and anxiety symptoms (Hospital Anxiety and Depression Scale), coping skills (Measure of Current Status), and self-efficacy (Cancer Self-Efficacy Scale-Transplant) at enrollment (prior to HCT) and 60 days post-HCT. We used causal mediation regression models to examine whether changes in coping and self-efficacy mediated intervention effects on QOL, as well as depressive and anxiety symptoms. RESULTS: Improvements in 60-day QOL in patients assigned to BMT-CARE were partially mediated by improved coping and self-efficacy (indirect effect=6.93, SE=1.85, 95% CI [3.71, 11.05]). Similarly, reductions in 60-day depression and anxiety symptoms were partially mediated by improved coping and self-efficacy (indirect effect depression=−1.19, SE=0.42, 95% CI [−2.23, −0.53]; indirect effect anxiety=−1.46, SE=0.55, 95% CI [−2.52, −0.43]). Combined improvements in coping and self-efficacy accounted for 67%, 80%, and 39% of the total intervention effect on QOL and depression and anxiety symptoms, respectively. CONCLUSIONS: Coping and self-efficacy are essential components of a brief psychosocial intervention that improves QOL and mood for caregivers of HCT recipients during the acute recovery period. PRECIS: A brief multimodal psychosocial intervention improved quality of life and reduced depression and anxiety symptoms for caregivers of patients undergoing stem cell transplant, compared to a usual care control group. These effects were partially mediated by improvements in coping skills and self-efficacy for caregivers assigned to the intervention. LAY SUMMARY: We previously reported that a six-session program (BMT-CARE), focused on providing medical information, caregiving skills, and self-care and coping strategies, improved quality of life (QOL) and mood of caregivers of hematopoietic stem cell transplantation (HCT) recipients, compared to a group of caregivers who received care as usual. Using statistical models, our findings suggest that learning coping skills and improving self-efficacy were the most essential components of this program that likely led to better QOL and mood for those caregivers.
Databáze: OpenAIRE
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