Care Partners: Web-based Support for Caregivers of Veterans Undergoing Chemotherapy
| Status: | Completed |
|---|---|
| Conditions: | Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | October 2009 |
| End Date: | February 2015 |
Web-based Support for Caregivers of Veterans Undergoing Chemotherapy
Given the growing strain on the Veterans Administration resulting from increasing caseloads
of cancer patients, interventions are badly needed that assist patients in managing their
illness, improve quality of life and avoid acute episodes that result in urgent care use and
increased mortality. Previous studies have found that cancer patients undergoing
chemotherapy can effectively manage their own symptoms when monitored using automated
telephone calls. Such technology, however, may challenge the number of Veterans who lack
social support and/or independence. The goal was to develop and test a technology that not
only monitors patients automatically by telephone, but also gives them self management
advice and engages a friend or family member to serve as a CarePartner willing to play a
limited role in identifying patient symptoms and psychosocial needs to reinforce self
management and provide social support. The investigators found that this technology indeed
helped patients better control their symptoms, especially when a caregiver participated in
the program along with them.
of cancer patients, interventions are badly needed that assist patients in managing their
illness, improve quality of life and avoid acute episodes that result in urgent care use and
increased mortality. Previous studies have found that cancer patients undergoing
chemotherapy can effectively manage their own symptoms when monitored using automated
telephone calls. Such technology, however, may challenge the number of Veterans who lack
social support and/or independence. The goal was to develop and test a technology that not
only monitors patients automatically by telephone, but also gives them self management
advice and engages a friend or family member to serve as a CarePartner willing to play a
limited role in identifying patient symptoms and psychosocial needs to reinforce self
management and provide social support. The investigators found that this technology indeed
helped patients better control their symptoms, especially when a caregiver participated in
the program along with them.
Cancer is a prevalent problem that causes much suffering among Veterans and their families.
Most interventions to improve symptom control require Veterans to engage in activities such
as managing medications, altering diets, or accessing outside resources that may be beyond
their reach due to limitations in physical and mental functioning. Friends and family inside
and outside of the Veteran's household can help, but often lack the skills and resources
they need to do so.
"Cancer CarePartners" was designed to address these needs by providing cancer-stricken
Veterans and their informal caregivers with the information they need to make effective
management decisions, decrease symptom burden, and improve outcomes. Cancer CarePartners is
a Web-enabled program that alerts caregivers of patients' symptoms and provides them with a
framework for identifying problems, receiving structured advice, formulating a 'task list,'
and following up with their patients as they receive chemotherapy. Specifically, Cancer
CarePartners includes weekly, automated telephonic symptom assessment (ATSA) with
self-management (SM) support to the Veteran paired with Web-based alerts to the caregiver
pointing them to a website where s/he can obtain customized advice. A randomized control
trial was conducted to test the efficacy of this program in controlling symptoms as well as
improving adherence to chemotherapy.
Objectives
1) To determine if Veterans undergoing chemotherapy who receive Cancer CarePartners report
significant improvement in the summed severity of symptoms (the sum of 0-10 severity across
8 core symptoms) compared to Veterans receiving symptom monitoring and self-management
advice; secondarily, to determine if they experience better adherence to chemotherapy and
utilization. (2) To determine if caregivers participating in the intervention provide
significantly more social support to patients than do controls; secondarily, to determine if
they experience more caregiver burden and distress than do controls. (3) To determine
whether impacts on patients are mediated by mastery. (4) To determine whether impacts on
caregivers are mediated by mastery.
Methods Consenting Veterans with solid tumors undergoing chemotherapy at one of three VAMCs
(Ann Arbor, Loma Linda and Fargo) who reported at least one core symptom at a moderate level
or higher and had a caregiver willing to enroll in the study were randomly assigned to
either 10 weeks of Cancer CarePartners or 10 weeks of automated, telephonic symptom
assessment (ATSA) with self management support. Arms were balanced for non-small cell lung
cancer status and caregiver type. Patients and caregivers were surveyed at intake, 10, and
14 weeks. In addition, the investigators tracked patient participation with ATSA and (in the
experimental arm) caregiver use of the Cancer CarePartners Website. The investigators
reviewed all medical records for content of care received during the 14 weeks on study.
Most interventions to improve symptom control require Veterans to engage in activities such
as managing medications, altering diets, or accessing outside resources that may be beyond
their reach due to limitations in physical and mental functioning. Friends and family inside
and outside of the Veteran's household can help, but often lack the skills and resources
they need to do so.
"Cancer CarePartners" was designed to address these needs by providing cancer-stricken
Veterans and their informal caregivers with the information they need to make effective
management decisions, decrease symptom burden, and improve outcomes. Cancer CarePartners is
a Web-enabled program that alerts caregivers of patients' symptoms and provides them with a
framework for identifying problems, receiving structured advice, formulating a 'task list,'
and following up with their patients as they receive chemotherapy. Specifically, Cancer
CarePartners includes weekly, automated telephonic symptom assessment (ATSA) with
self-management (SM) support to the Veteran paired with Web-based alerts to the caregiver
pointing them to a website where s/he can obtain customized advice. A randomized control
trial was conducted to test the efficacy of this program in controlling symptoms as well as
improving adherence to chemotherapy.
Objectives
1) To determine if Veterans undergoing chemotherapy who receive Cancer CarePartners report
significant improvement in the summed severity of symptoms (the sum of 0-10 severity across
8 core symptoms) compared to Veterans receiving symptom monitoring and self-management
advice; secondarily, to determine if they experience better adherence to chemotherapy and
utilization. (2) To determine if caregivers participating in the intervention provide
significantly more social support to patients than do controls; secondarily, to determine if
they experience more caregiver burden and distress than do controls. (3) To determine
whether impacts on patients are mediated by mastery. (4) To determine whether impacts on
caregivers are mediated by mastery.
Methods Consenting Veterans with solid tumors undergoing chemotherapy at one of three VAMCs
(Ann Arbor, Loma Linda and Fargo) who reported at least one core symptom at a moderate level
or higher and had a caregiver willing to enroll in the study were randomly assigned to
either 10 weeks of Cancer CarePartners or 10 weeks of automated, telephonic symptom
assessment (ATSA) with self management support. Arms were balanced for non-small cell lung
cancer status and caregiver type. Patients and caregivers were surveyed at intake, 10, and
14 weeks. In addition, the investigators tracked patient participation with ATSA and (in the
experimental arm) caregiver use of the Cancer CarePartners Website. The investigators
reviewed all medical records for content of care received during the 14 weeks on study.
Inclusion Criteria:
- Patients must be 18 years or older, cognitively intact, English-speaking, able to
hear, and own a telephone.
- Patients can have any solid tumor.
- Patients must be initiating IV cytotoxic chemotherapy and, if recurrent, have
experienced a 1 month treatment free interval.
- Caregivers must be 18 years or older, cognitively intact, English-speaking, and able
to hear/speak for interviews.
- Caregivers must have access to a telephone and computer with high speed internet
access.
Exclusion Criteria:
- Patients will be excluded if they have a hematologic malignancy or are receiving bone
marrow transplantation.
- Patients and caregivers will be excluded if they have an untreated serious mental
illness or cognitive impairment, are institutionalized or enrolled in hospice (prior
to trial), or plan on not receiving all care from VA
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