Improving Cancer Family Caregivers’ Knowledge and Communication About Care Options

Overview

The purpose of this two-year mixed methods study is to develop and test an intervention to improve cancer family caregivers' knowledge of care options (curative, palliative, and hospice care) and goals of care communication as part of a self-management (SM) training program. The two specific aims of this project are to: 1. Develop a psycho-educational intervention called Managing Cancer Care: A Caregiver's Guide (MCC-CG), for family caregivers of patients with breast cancer to increase knowledge of care options, goals of care communication, and other SM skills. 2. Evaluate the feasibility and preliminary efficacy of the MCC-CG in a pilot randomized controlled trial compared with an attention-control condition (symptom management education) on knowledge of care options, goals of care communication, and other key SM skills (engagement in SM, management of transitions and uncertainty, increasing self-efficacy, appropriate use of health care resources).

Full Title of Study: “Improving Cancer Family Caregivers’ Knowledge and Communication About Care Options”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Supportive Care
    • Masking: Single (Participant)
  • Study Primary Completion Date: November 9, 2016

Detailed Description

The investigators will address and accomplish aim 1 by taking the following steps: 1. Conduct development focus groups with family caregivers of women with breast cancer. 2. Develop the MCC-CG intervention prototype. 3. Conduct feedback focus groups with family caregivers to evaluate the prototype. 4. Revise the MCC-CG. To address and accomplish aim 2, the investigators will do the following: 1. Conduct a pilot RCT to evaluate the feasibility of recruiting and retaining a sample of family caregivers. 2. Assess the initial efficacy of the MCC-CG to improve knowledge of care options, goals of care communication, and other SM skills. 3. Estimate power and determine the best measures for a large RCT testing the MCC-PT and MCC-CG together.

Interventions

  • Other: Managing Cancer Care: A Caregiver’s Guide
    • MCC-CG is a set of 7 printed modules including information about caregiver-nominated SM topics, conversation starters to facilitate communication with patients and providers, and links to caregiver resources. The modules are as follows: Becoming a Cancer Caregiver [role, changes, challenges, adjusting, self-care] Basics of Cancer Caregiving [physical, functional, emotional, social, & spiritual support; treatment timeline worksheet] Caregiver’s Role in Managing Patient Care [who/what is involved; health care professionals worksheet] Managing Cancer Symptoms and Side Effects [common symptoms/side effects; maintaining health; nutrition & exercise; medication management worksheet] Care Options: [information on curative, palliative and hospice care] Talking About Goals of Care [information on goals of care conversations] Managing Transitions [defining transitions, transition examples, helping yourself and patient to manage transitions; transitions worksheet]
  • Other: Symptom Management Toolkit
    • Along with an overview of symptom management, the Toolkit provides concise information on commonly experienced symptoms, including fatigue, alopecia, cognitive dysfunction, nausea and vomiting, and sleep problems, among others. Each chapter uses a question-and-answer format to cover the topics of who is most likely to experience the symptom, when and why the symptom may occur, how the symptom can be managed, and when to call a provider. Drs. Schulman-Green and McCorkle have previously tested the Symptom Toolkit in an attention-control group.

Arms, Groups and Cohorts

  • Experimental: Intervention
    • Family caregivers of breast cancer patients who consent to participate in the study have a 50/50 chance of being randomized to the intervention group and will receive the booklet, Managing Cancer Care: A Caregiver’s Guide (MCC-CG) (N=18)
  • Active Comparator: Control
    • Family caregivers of breast cancer patients who consent to participate in the study have a 50/50 chance of being randomized to the control group and will receive the Symptom Management Toolkit (N=17)

Clinical Trial Outcome Measures

Primary Measures

  • Knowledge of Care Options (KOCO)
    • Time Frame: 3 months
    • 11-item questionnaire in true/false format to assess knowledge of curative, palliative, and hospice care.
  • Medical Communication Competence Scale (MCCS)
    • Time Frame: 3 months
    • Adjusted to reflect views of the family caregiver, the MCCS will assess participants’ communication skills, including information seeking, providing, and verifying, and socio-emotional communication will be measured using the MCCS. Each item on the MCCS is presented with a Likert scale ranging from 7 (strongly agree) to 1 (strongly disagree).
  • Engagement in Cancer Self-Management Activities Scale (ECSMAS)
    • Time Frame: 3 months
    • The 33-item ECSMAS was developed to measure cancer patients’ self-reported self-management. The ECSMAS is organized around three conceptual domains derived from a metasynthesis of process of self-management in chronic illness: focus on illness needs, activating resources, and living with chronic illness. Items are adjusted to reflect views of the family caregiver, and an additional item has been added to the ECSMAS to assess caregivers’ ability to manage transitions as a self-management skill (34 items total).

Secondary Measures

  • Goals of Care Conversation
    • Time Frame: 3 months
    • This form documents frequency, perceived quality, and content of goals of care conversations with patients and providers, as well as capturing any transitions experienced.
  • Caregiver Burden Scale (CBS)
    • Time Frame: 3 months
    • This 22-item scale was developed to assess the experience of burden among caregivers, specifically addressing the dimensions of personal strain and role strain. Each item is presented with five response options ranging from 0-4 indicating “never”, “rarely”, “sometimes”, “frequently”, and “nearly always” sequentially.
  • Mishel Uncertainty in Illness Scale (MUIS)
    • Time Frame: 3 months
    • Uncertainty will be measured using the 32-item MUIS, which was developed to measure the uncertainty adults perceive regarding symptoms, diagnosis, relationships, and planning for the future. Each item on the MUIS represents uncertainty in terms of a 5-point Likert-type format ranging from 1 (strongly disagree) to 5 (strongly agree). All items adjusted to reflect views of the caregiver.
  • Caregiver Competence Scale
    • Time Frame: 3 months
    • Self-efficacy will be measured using a 4-point Likert scale, with four questions total.
  • Personal Gain Scale
    • Time Frame: 3 months
    • Self-efficacy will be measured using a 4-point Likert scale, with four questions total.

Participating in This Clinical Trial

Inclusion Criteria

  • A family member of an individual with any stage of breast cancer receiving curative, palliative, or hospice care – Aged 18+ – English speaking – Live in Connecticut – The patient for whom the participant is a caregiver has a six-month prognosis

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 110 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Yale University
  • Collaborator
    • Icahn School of Medicine at Mount Sinai
  • Provider of Information About this Clinical Study
    • Principal Investigator: Dena-Schulman-Green, Research Scientist – Yale University
  • Overall Official(s)
    • Dena J Schulman-Green, PhD, Principal Investigator, Yale School of Nursing

References

McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, Wagner EH. Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin. 2011 Jan-Feb;61(1):50-62. doi: 10.3322/caac.20093. Epub 2011 Jan 4.

Schulman-Green D, Ercolano E, Jeon S, Dixon J. Validation of the knowledge of care options instrument to measure knowledge of curative, palliative, and hospice care. J Palliat Med. 2012 Oct;15(10):1091-9. doi: 10.1089/jpm.2011.0514. Epub 2012 Jun 13.

Schulman-Green D, Jaser S, Martin F, Alonzo A, Grey M, McCorkle R, Redeker NS, Reynolds N, Whittemore R. Processes of self-management in chronic illness. J Nurs Scholarsh. 2012 Jun;44(2):136-44. doi: 10.1111/j.1547-5069.2012.01444.x. Epub 2012 May 2.

Grey M, Schulman-Green D, Knafl K, Reynolds NR. A revised Self- and Family Management Framework. Nurs Outlook. 2015 Mar-Apr;63(2):162-70. doi: 10.1016/j.outlook.2014.10.003. Epub 2014 Oct 15.

Schulman-Green D, Jeon S. Printed guide improves knowledge of curative, palliative, and hospice care among women with metastatic breast cancer. Support Care Cancer. 2013 Oct;21(10):2651-3. doi: 10.1007/s00520-013-1864-x. Epub 2013 Jun 1. No abstract available.

Schulman-Green D, Jeon S. Managing Cancer Care: a psycho-educational intervention to improve knowledge of care options and breast cancer self-management. Psychooncology. 2017 Feb;26(2):173-181. doi: 10.1002/pon.4013. Epub 2015 Nov 4.

Hinchey J, Goldberg J, Linsky S, Linsky R, Jeon S, Schulman-Green D. Knowledge of Cancer Stage among Women with Nonmetastatic Breast Cancer. J Palliat Med. 2016 Mar;19(3):314-7. doi: 10.1089/jpm.2015.0133. Epub 2016 Feb 8.

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