Psychoeducation For BMT Caregivers: Biobehavioral Markers and Outcome
- Further validate a unique saliva collection device in a randomized controlled study of
a psychoeducation, paced respiration, and relaxation (PEPRR) intervention for
caregivers of patients undergoing bone marrow transplantation.
- Evaluate the suitability of paced respiratory training using RESPeRATE™ for these
- Determine the efficacy of a PEPRR intervention on behavioral (stress level, mood and
overall health) and physiological (neuroendocrine function, immune function, and sleep)
outcomes of these caregivers.
OUTLINE: Caregivers are randomized to 1 of 2 groups.
- Group I (treatment as usual [TAU]): Caregivers and patients attend a 2-hour orientation
class that provides an overview of the transplant process, information regarding
financial issues and resources that may be available to the patient and caregiver, a
review of caregiver duties, dietary restrictions post-transplantation, a brief
introduction to stress and stress management, and hands-on training of how to care for
a central venous catheter. Patients also receive information in the form of a written
manual that provides in-depth information about transplant, including how the
transplant works, what to expect, caregiver duties, graft-vs-host disease, and when to
contact medical staff for assistance. A voluntary 1-hour weekly caregiver support group
is offered on the inpatient BMT unit.
- Group II (psychoeducation, paced respiration, and relaxation [PEPRR]): Caregivers and
patients attend a 2-hour orientation class identical to group I. Caregivers also
participate in the PEPRR intervention comprising an individualized stress management
component and educational component that addresses the psychosocial needs of the
caregivers. It also provides self-care and adaptive coping skills. The stress
management component addresses caregivers' perception of potential stressors (primary
appraisal); perceived ability to control or manage the stressor (secondary appraisal);
ability to exert control and cope with the stressor (coping effort); and ongoing
evaluation of the stressor and their perceived ability of managing the stressor
(reappraisal) and applies coping strategies such as relaxation, prioritizing, goal
setting, pacing, and communicating needs. The PEPRR intervention consists of 8 sessions
(4 weekly 60-minute sessions followed by 4 biweekly 60-minute sessions) that cover the
100-day period of caregiving post-transplantation. Caregivers also undergo paced
respiratory (RESPeRATE™) training for 15 minutes once daily over 12 weeks that measures
caregiver adherence and compliance to the relaxation program.
Caregivers and patients undergo psychosocial assessments at approximately 1-3 months prior
to randomization and transplantation and again at 1, 3, 6, and 12 months after
transplantation. Caregivers also complete questionnaires to assess their stress (PSS, CRA,
and IES), mood (POMS, CES-D, and STAI), sleep (PSQI), and health (SF-36).
Caregivers undergo blood and saliva sample collection at baseline and periodically during
study for biomarker analysis (e.g., neuroendocrine and immune markers). Caregivers wear an
activity watch (actimeter) during each saliva sample collection period.
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Investigator), Primary Purpose: Treatment
Behavioral - Stress level as measured by the Perceived Stress Scale (PSS)
Caregiver stress will be assessed with the Perceived Stress Scale (PSS) (Cohen et al., 1983), identifying the degree to which situations in life are perceived as stressful. Items on the PSS measure the degree to which the subjects feel their lives are unpredictable, uncontrollable and overwhelming on a 5 point Likert scale. The shorter 10-item scale was validated in 2,387 respondents across demographic characteristics (i.e. age, gender, socioeconomic status, race) (Cohen, Kessler, & Gordon, 1995) with superior psychometric properties (reliability alpha of 0.84).
Baseline (prior to transplant), 1, 3, 6, 12 post transplant
Mark Laudenslager, PhD
University of Colorado, Denver
United States: Institutional Review Board
|University of Colorado Cancer Center at UC Health Sciences Center||Aurora, Colorado 80045|
|Presbyterian/St. Luke's Medical Center (PSLMC) - Denver Midtown||Denver, Colorado 80218|