title: A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: effects on distress.
abstract: Caregivers of patients receiving allogeneic hematopoietic stem cell transplants (allo-HSCT) serve a pivotal role in patient care but experience high stress, anxiety and depression as a result. We theorized that stress management adapted for allo-HSCT caregivers would reduce distress compared with treatment as usual (TAU). Of 267 consecutive caregivers of allo-HSCT patients approached, 148 (mean=53.5 years, 75.7% female) were randomized to either psychosocial intervention (i=74) or TAU (n=74). Eight one-on-one stress management sessions delivered across the 100-day post-transplant period focused on understanding stress, changing role(s) as caregiver, cognitive behavioral stress management, pacing respiration and identifying social support. Primary outcomes included perceived stress (psychological) and salivary cortisol awakening response (CAR) (physiological). Randomized groups were not statistically different at baseline. Mixed models analysis of covariance (intent-to-treat) showed that intervention was associated with significantly lower caregiver stress 3 months post transplant (mean=20.0, 95% confidence interval (95% CI)=17.9-22.0) compared with TAU (mean=23.0, 95% CI=21.0-25.0) with an effect size (ES) of 0.39 (P=0.039). Secondary psychological outcomes, including depression and anxiety, were significantly reduced with ESs of 0.46 and 0.66, respectively. Caregiver CAR did not differ from non-caregiving controls at baseline and was unchanged by intervention. Despite significant caregiving burden, this psychosocial intervention significantly mitigated distress in allo-HSCT caregivers.
authors.affiliation: Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Laudenslager
authors.affiliation: Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Simoneau
authors.affiliation: Department of Psychology, Univerity of Colorado Denver, Denver, CO, USA.
authors.forename: K
authors.initials: K
authors.lastname: Kilbourn
authors.affiliation: Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: C
authors.initials: C
authors.lastname: Natvig
authors.affiliation: Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: S
authors.initials: S
authors.lastname: Philips
authors.affiliation: 1] Presbyterian/St Luke's Medical Center, Denver, CO, USA [2] Colorado Blood Cancer Institute, Denver, CO, USA.
authors.forename: J
authors.initials: J
authors.lastname: Spradley
authors.affiliation: Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: P
authors.initials: P
authors.lastname: Benitez
authors.affiliation: 1] Presbyterian/St Luke's Medical Center, Denver, CO, USA [2] Colorado Blood Cancer Institute, Denver, CO, USA.
authors.forename: P
authors.initials: P
authors.lastname: McSweeney
authors.affiliation: Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Mikulich-Gilbertson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D017028:Caregivers; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012944:Social Support; D013315:Stress, Psychological / Q000378:metabolism / Q000628:therapy*