Multimodal Psychosocial Intervention for Caregivers of Patients Undergoing Hematopoietic Stem Cell Transplantation (HCT): A Randomized Clinical Trial

Abstract

Background Caregivers (i.e., family and friends) of patients undergoing HCT experience immense caregiving burden during HCT. Multimodal interventions to address the needs of caregivers prior to, during, and after HCT are lacking. Methods We conducted a randomized trial of a multimodal psychosocial intervention (BMT-CARE) for caregivers of patients undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomly assigned to BMT-CARE or usual care. BMT-CARE was tailored to the HCT trajectory and integrated treatment-related education and self-care with cognitive-behavioral skills and caregiving-specific strategies to promote coping. Caregivers assigned to BMT-CARE met with a trained interventionist in-person, via telephone or videoconferencing for six sessions starting prior to HCT and up to day+60 post-HCT. We assessed Caregiver quality of life (QOL; CareGiver-Oncology-Questionnaire), caregiving burden (Caregiver Reaction Assessment), psychological distress (Hospital Anxiety and Depression Scale), self-efficacy (Cancer Self-Efficacy Scale-Transplant), and coping (Measures of Current Status) at baseline and 60 days post-HCT. We assessed the preliminary efficacy of BMT-CARE for improving caregiver-reported outcomes at 60 days post-HCT using analysis of covariance adjusting for baseline criterion values. We conducted causal mediation analyses to examine whether changes in self-efficacy or coping mediated the effect of the intervention on caregiver QOL and psychological distress at 60 days post-HCT. Results We enrolled 72.5% (100/138) of eligible caregivers. Caregivers randomized to BMT-CARE reported improved QOL (adjusted means: 81.22 [95%CI 77.69, 84.74] vs. 70.96 [95%CI 67.56, 74.36], P Conclusions A brief multimodal psychosocial intervention tailored for caregivers of HCT recipients has promising efficacy for improving QOL, mood, coping, and self-efficacy while reducing caregiving burden during the acute HCT period. Improvements in coping skills and self-efficacy partially account for the effect of BMT-CARE on caregiver QOL and psychological distress.