Interventions For Caregivers Research Articles

Caring the caregivers. An online psychological intervention for family caregivers of oncological palliative patients

Aim: analyze the effectiveness of an online delivered psychological intervention program for oncological palliative caregivers in order to reduce the distress and caregiver burden. Methods: The program was developed for primary caregivers of advanced cancer patients, with a life expectancy of less than 6 months. The intervention consisted of 4 weekly sessions. The assessment instruments were the Caregiver Emotional Distress Detection Scale and the Zarit’s Reduced Scale and were applied at the beginning and end of the program. In addition, the main worries of the caregivers were categorized by the Caregiver Emotional Distress Detection Scale. Descriptive statistics and Student’s t were used. Results: 38 caregivers enrolled in intervention, 81.6% of whom were women. Regarding the degree of kinship, 44.7% were descendants of the patient. The distress was significantly reduced after the intervention. Uncertainty remained the main worry at both moments of measurement. Before the program, the second most frequent worry was the suffering of the patient, while after the intervention it was worries about the suffering of other family members. Conclusions: Carrying out this online group psychological intervention program proved to be effective in reducing emotional distress in the main caregivers of cancer patients at the end of life. Uncertainty was a constant concern throughout the program in the relatives.

Cultural adaptation of an intervention for caregivers of young autistic children: Community members' perspectives.

Caregivers of autistic children in low-to-middle-income countries experience many barriers to access resources to support their child's development. Caregiver training is considered an evidence-based practice and may be a cost-effective way to support caregivers of autistic children in such settings. This study focuses on the cultural adaptation of Parents Taking Action (PTA; Magaña etal., Family Process, 56, 57-74, 2017) to support caregivers of autistic children in Paraguay. We conducted focus groups and individual interviews with 28 caregivers, autistic individuals, and professionals in Paraguay to understand caregivers' needs and to explore needed cultural adaptations of PTA to achieve contextual fit. Participants identified caregivers' need for accurate and reliable information, strategies to support children's growth, and emotional support and strategies to manage stress. Additionally, participants provided recommendations for adapting PTA considering the dimensions within the Cultural Adaptation Checklist (Lee etal., International Journal of Developmental Disabilities, 2023). This study is the first step in the iterative process of culturally adapting an intervention and the process described in this study may be appropriate for culturally adapting other interventions.

Telephone-Assisted Self-Help for Caregivers of Adolescents with Attention-Deficit/Hyperactivity Disorder: An Observational Proof-of-Concept Study

Studies on the treatment of attention-deficit/hyperactivity disorder (ADHD) in adolescence indicate small to moderate treatment effects (e.g., of parent training). Self-help interventions might overcome structural and personal barriers to treatment utilization. The present proof-of-concept study examined the feasibility and effectiveness of a twelve-month, telephone-assisted self-help (TASH) intervention for caregivers of adolescents with ADHD. This intervention comprised 8 booklets on the management of ADHD-related problems and 14 telephone counseling sessions. Sixty-six caregivers participated in the study with a one-group pretest-posttest design (intention-to-treat sample). Of these, forty-three families completed the intervention in accordance with the study protocol (per-protocol sample). Compared to families with early discontinuation (n = 23, drop-out sample), adolescents in the per-protocol sample demonstrated a higher level of caregiver-rated emotional problems and a lower level of quality of life at pre-assessment. Caregivers in the per-protocol sample showed high adherence and reported high satisfaction with the intervention. Analyses of the per-protocol sample yielded significant, moderate to large pre-to-post improvements in caregiver-rated ADHD symptoms (primary outcome; d = 0.81, 95% confidence interval [0.51, 1.11]), oppositional, emotional and behavioral problems and quality of life of the adolescents, and caregiver self-efficacy during the intervention. In intention-to-treat analyses, which considered data of all 66 participants who had originally participated in the study, the pre-post differences in ADHD symptoms, emotional and behavioral problems, and quality of life remained at their significant level. These results provide initial support for the feasibility and effectiveness of the TASH intervention. Its efficacy compared to control conditions remains to be examined.

A Web-Based Intervention Based on Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Mixed Methods Feasibility Study.

Acceptance and commitment therapy (ACT), as an empirically based third-wave cognitive behavioral therapy, has shown promise in enhancing well-being and functioning across diverse populations. However, in the context of caregiving, the effect size of available ACT interventions remains at best moderate, sometimes accompanied by high dropout rates, highlighting the need for more effective and feasible intervention designs. The objective of our study was to evaluate the feasibility and acceptability of a fully online ACT program designed for family caregivers of people with dementia. This study aimed to boost psychological flexibility and support caregivers, enabling them to realize and prioritize their own life values alongside their caregiving responsibilities. A mixed methods feasibility study using an uncontrolled pretest-posttest design was conducted. This intervention included a 9-week web-based self-help program based on ACT incorporating collaborative goal setting and weekly web-based motivational coaching for family caregivers of people with dementia. This study involved 30 informal caregivers recruited through memory clinics and social media platforms in the Netherlands and received approval from the Medical Ethics Committee of the Maastricht University Medical Center+ (NL77389.068.21/metc21-029). A total of 24 caregivers completed the postintervention assessment, indicating a high adherence rate (24/29, 83%). Caregivers reported positive feedback regarding collaborative goal setting, but some found challenges in implementing new skills due to their own habitual responses or the unpredictable context of dementia caregiving. Personalizing the intervention based on individual value preferences was highlighted as beneficial. Compared to other web-based self-help ACT interventions for family caregivers, this intervention showed a high adherence and sufficient level of feasibility, which underscores the use of personalization in delivering web-based interventions. Moreover, the potential of this ACT-based intervention for family caregivers of people with dementia was demonstrated, suggesting that further research and a larger-scale controlled trial are warranted to validate its effectiveness. RR2-10.1136/bmjopen-2022-070499.

Promoting Healthy Screen Media Use in Young Children With Externalizing Behavior Problems Through an Adapted Parenting Intervention: Results of an Open Trial

In this article, we describe the development of an adapted parenting intervention for caregivers of preschoolers with externalizing behavior problems, which integrates content around screen media use into an existing evidence-based parenting intervention. We also present results of an open trial examining the feasibility, acceptability, and initial outcomes of the adapted intervention in a sample of 10 low-income caregivers of children with externalizing behavior problems who were attending a community-based therapeutic summer program. Caregivers attended a once weekly (1.5-hour) intervention group, which was embedded in an 8-week community-based therapeutic program for children with externalizing behavior, and completed questionnaires at pretest, posttest, and 1 month following the intervention, and completed interviews about their experiences. Caregiver satisfaction with the adapted intervention was high, and fidelity and attendance measures suggested the intervention was feasible. Preliminary results showed postintervention improvements in caregivers’ skills in managing screen media use, including increases in caregiver self-efficacy to manage and set limits around screen media use. Results suggest that leveraging existing parenting interventions to promote healthy media use habits may be a promising avenue to maximize reach to families with children with externalizing behavior.

Qualitative Analysis of Implementation Factors of an Embedded Caregiver Support Intervention into Adult Day Services.

Adult day services (ADS) are an important and often underutilized support resource for older adults. For persons living with dementia (PLWD), ADS is an optimal access point to not only receive therapeutic and rehabilitative activities, but as a vehicle for respite/relief for dementia caregivers. Yet, there is currently a lack of research on integrating caregiver interventions into home and community-based services such as ADS. This paper reports on qualitative findings from the Improving Outcomes for Family Caregivers of Older Adults with Complex Conditions: The Adult Day Plus (ADS Plus) Program Trial. Drawing from semi-structured interviews conducted with family caregivers and ADS site staff, we conducted a thematic analysis to examine the implementation process of ADS Plus. Themes address the relational nature of the intervention, learning, influence of the administrative infrastructure, and receptivity of ADS Plus. Our analysis determined that implementation of ADS Plus was feasible and accepted by site staff and dementia caregivers but also calls for additional evaluation of embedded caregiver support interventions across different contexts (e.g., staff size, limited technology environments) to further identify and test implementation mechanisms across settings.

Chinese caregivers’ attitudes towards ABA-based interventions for their autistic children: a qualitative exploration

Objectives Interventions based on Applied Behavior Analysis (ABA) are increasingly used for autistic children in China. However, there is limited knowledge about the attitudes of Chinese caregivers towards ABA-based interventions and their lived experiences. This study aims to preliminarily investigate caregiver experience and perceptions regarding ABA-based interventions through a phenomenological approach. Methods Eight Chinese caregivers of autistic children were interviewed to understand their attitudes towards and experiences of ABA-based interventions. Half of the caregivers’ autistic children were receiving ABA-based interventions, while the other half’s autistic children previously received ABA-based interventions. Results Five major themes were identified through analysis: 1) The beginning and termination of ABA-based interventions; 2) Mixed experiences of ABA-based interventions; 3) The high cost of ABA-based interventions; 4) The involvement of caregivers in ABA-based interventions; 5) Thoughts regarding ideal ABA-based interventions in future China. Both caregiver groups shared positive and negative experiences related to ABA-based interventions. Caregivers expressed concern regarding the quality, accessibility, and sustainability of ABA-based interventions in their communities and the country. Conclusions Implications for policymakers, service providers, and caregivers are discussed: 1) Enhancing the professional workforce for ABA-based interventions; 2) Empowering advocacy and navigating culture; 3) Optimizing the distribution of ABA resources in China; 4) Developing caregiver training and family-centered ABA-based interventions.

Effectiveness of Postnatal Maternal or Caregiver Interventions on Outcomes among Infants under Six Months with Growth Faltering: A Systematic Review.

The care of infants at risk of poor growth and development is a global priority. To inform new WHO guidelines update on prevention and management of growth faltering among infants under six months, we examined the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants between 0 and 6 months. We searched nine electronic databases from January 2000 to August 2021, included interventional studies, evaluated the quality of evidence for seven outcome domains (anthropometric recovery, child development, anthropometric outcomes, mortality, readmission, relapse, and non-response) and followed the GRADE approach for certainty of evidence. We identified thirteen studies with preterm and/or low birth weight infants assessing effects of breastfeeding counselling or education (n = 8), maternal nutrition supplementation (n = 2), mental health (n = 1), relaxation therapy (n = 1), and cash transfer (n = 1) interventions. The evidence from these studies had serious indirectness and high risk of bias. Evidence suggests breastfeeding counselling or education compared to standard care may increase infant weight at one month, weight at two months and length at one month; however, the evidence is very uncertain (very low quality). Maternal nutrition supplementation compared to standard care may not increase infant weight at 36 weeks postmenstrual age and may not reduce infant mortality by 36 weeks post-menstrual age (low quality). Evidence on the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering is limited and of 'low' to 'very low' quality. This emphasizes the urgent need for future research. The protocol was registered with PROSPERO (CRD42022309001).

Logotherapy-Based Interventions for Chinese Family Caregivers of Older Adults with Dementia Through Online Groups: A Mixed-Methods Study

ABSTRACT Chinese family caregivers of people with dementia (PWD) can suffer from physical and psychological burden. This study aimed to examine the effects of logotherapy-based interventions on Chinese family caregivers of older adults with dementia to decrease caregiver burden. This mixed-methods study used a pre-experimental design with pre-posttests and semi-structured interviews. A purposive sample of 13 family caregivers from a suburban district in Shanghai was enrolled with (1) caregiver burden and (2) access and capability to use smart devices. Participants received eight online group logotherapy sessions with a focus on hope and meaning construction. Participants completed the Zarit Burden Interview, a 22-item measure of caregiver burden, before and after the intervention, and a 30-min semi-structured interview post-intervention. From the quantitative data, dementia caregivers reported severe caregiving burdens at the baseline (M = 54.77, SD = 9.33). Caregiver burden significantly decreased after the logotherapy-based intervention (M = 52.15, SD = 8.80, p < .001). Two themes pertaining to participants’ experiences in intervention emerged from the qualitative data: (1) improved attitudes toward suffering, and (2) enhanced sense of meaning in life and hope. The cultural relevance of logotherapy to Chinese familism and Confucianism may further enhance its feasibility in the Chinese context.

Alzheimer Hastası Bakım Vereninde Kişilerarası Psikoterapi Yaklaşımı: Olgu Sunumu

Alzheimer's Disease, which is turning into a public health problem in elderly societies, is characterized by significant deterioration in cognitive as well as behavioral processes, and is defined as a neurodegenerative disease, has a challenging process, especially for caregivers. The caregiver, who is seen as the main decision-maker in the disease, may experience problems with both the patient and the environment due to the burden of care, lack of knowledge about the disease, and the weakness of support networks. While the caregiver tries to manage the disease process, they also face loss and mourning. For this reason, especially the difficulty in accepting and adapting to changing roles brings about conflicts in relationships with the patient and others. At this point where support mechanisms gain importance, the Interpersonal Based Psychotherapy (IPT) Approach, which will be put into practice constructively, has a positive impact on caregiver relationships and makes the process bearable by reflecting positively on the prognosis of the disease. IPT is a psychotherapeutic approach used on many interpersonal problems and psychiatric syndromes, and works on the areas of interpersonal conflict, grief and loss, and role reversal. This case study aimed to evaluate the IPT Approach for D., who was caring for his father with Alzheimer's Disease. It has been seen that the approach plays an effective role when the caregiver's relationship with the patient and others is evaluated. Observed in literature studies is that positive interventions for caregivers have positive effects on both the patient and the caregiver. Olgu D., who experienced conflict in her relationships due to the weight of the burden of care and existing life responsibilities, along with the diagnosis of her father's illness, gained accurate information about the disease. At the same time with the therapeutic approach, the insight gained as a result of strengthening the support mechanisms, explaining the situation and the need for help, and the positive structuring of the social support network were achieved. Key Words: Alzheimer's Disease, Interpersonal Psychotherapy, Caregiver

Prevalence and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa

IntroductionBetween 10 and 20% of children and adolescents globally experience common mental health conditions such as depression or anxiety. Given the dearth of mental health services in low- and middle-income countries, most mental health conditions among adolescents remain undiagnosed and untreated. In South Africa, few studies have explored the prevalence of depression and anxiety among young adolescents aged 10–14 years. This study examined the prevalence of, and factors associated with depression and anxiety among young school-going adolescents in the Western Cape Province of South Africa. MethodsA cross-sectional study was conducted in 10 schools in the Western Cape Province from February to July 2022. Data were collected using a tablet-based survey and included sociodemographic items, the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire for Adolescents (PHQ-A) and other psychosocial measures. The prevalence of depression and anxiety was estimated based on cut-off scores for the GAD-7 and PHQ-A. Multivariable logistic regression models were used to investigate the associations between sociodemographic and psychosocial factors, and depression and anxiety. ResultsOf the 621 adolescents, 33.5% (n = 208) reported experiencing symptoms of depression and 20.9% (n = 130) symptoms of anxiety potentially indicative of a diagnosis. The results of the multivariable logistic regression model indicate that being in a higher grade in school (AOR = 1.65, CI:1.43–1.92), any lifetime alcohol use (AOR = 1.62, CI:1.04–2.64), other drug use (AOR = 2.07, CI:1.06–4.04), and witnessing violence among adults at home (AOR = 2.12, CI:1.07–1.41) were significantly associated with experiencing depressive symptoms. Being in a higher grade in school (AOR = 1.69, CI: 1.42–2.01), poor emotional regulation skills (AOR = 1.03, CI: 1.00–1.07), and the use of cannabis (AOR = 1.03, CI: 1.00–1.07) were significantly associated with experiencing anxiety symptoms. ConclusionThese findings add to our understanding of school-going adolescents' pressing mental health needs and suggest that mental health adolescent and caregiver interventions may be required to address mental health symptoms and associated risk factors.

Songwriting Group Music Therapy to promote psychological adjustment in informal caregivers of elderly people with dependency: a mixed methods study.

Informal caregivers of elderly people with dependency (EPD) provide intensive care that can affect their quality of life (QoL). Psychosocial interventions such as music therapy are important to work on their self-care. The aim of this study is to analyze, with a mixed method approach, the experience of participating in a Songwriting Group Music Therapy (SGMT) intervention on informal caregivers of EPD. A total of 11 groups, with a convenience sample of 61 caregivers, received 10 SGMT sessions. Quantitative information related to QoL variables (anxiety, depression, spirituality, burden, and coping) was collected before and after the intervention and at 3 months of follow-up. Regarding qualitative data, an open-ended question about the experience of participating was asked. Significant changes were shown, sustained over time, in trait anxiety and depression and subscales including inner peace, social functioning, and mental health. Three themes were generated from the thematic analysis, including that SGMT participation can enhance personal growth, bring out and enable work on emotions, and promote helpful interpersonal dynamics. The findings indicate that SGMT is a useful intervention for informal caregivers of EPD, promoting psychological adjustment, enhanced coping, emotional regulation, and social support. This study reinforces the findings with caregivers of other populations, providing new results and highlighting the benefits of SGMT for caregivers of EPD.

Effectiveness of family centred interventions for family caregivers: A systematic review and meta-analysis of randomized controlled trials.

To examine the effectiveness of family-centred interventions among family caregivers. Family-centred interventions are an emerging form of intervention that can be effective at improving physical and mental health outcomes for patients and family caregivers. To date, no reviews have examined the effectiveness of family-centred interventions for family caregivers. A systematic review, including a meta-analysis, was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) checklist. Seven English and two Chinese electronic databases were compressively searched from the outset to March 2023. Two researchers independently reviewed the abstracts and full texts, extracted the data and assessed the risk of bias independently by using the Cochrane 'Risk of bias assessment tool'. This systematic review and meta-analysis included 20 articles. The results of the meta-analysis showed that family-centred interventions could significantly improve caregiver burden (p=0.003), quality of life (p=0.007), depression (p=0.0002), and stress (p<0.0001) but not anxiety or family functioning. According to our subgroup analysis, the family-centred empowerment model (p=0.009) was superior to the other family intervention (p=0.004) in reducing caregiver burden. Family-centred interventions are more effective at reducing the burden of caregiving on family caregivers of adolescent patients (SMD=-0.79, 95% CI[-1.22,-0.36], p=0.0003) than on adult patients (SMD=-0.37, 95% CI [-0.61,-0.12], p=0.004). Family-centred interventions could enhance family caregivers' burden, quality of life, stress and depression but had no significant impact on anxiety or family functioning. Family-centred interventions have the potential to improve the health status and caregiving burden of family caregivers. Rigorous and high-quality evidence is needed to confirm the long-term effects of these interventions on family caregivers. The protocol has been registered in the PROSPERO international prospective register of systematic reviews (Protocol registration ID: CRD42023453607).

Relationship Between Acculturation and Mental Health in Korean American Family Caregivers of Community-Dwelling Persons Living with Dementia.

Despite the growing number of Korean American (KA) family caregivers for persons with dementia, little is known about how acculturation might affect caregiving stress in this population. Acculturation is a variable of considerable interest in caregiving research due to its significance in understanding the impact of cultural perceptions and expectations on the caregiving role and its relation to mental health outcomes. A cross-sectional descriptive study using baseline data from an ongoing randomized controlled trial of dementia caregiver intervention was performed to examine the association between acculturation and mental health outcomes among KA caregivers (n = 32) for persons with dementia. Self-report survey questionnaires including a bidirectional acculturation scale, Center for Epidemiologic Studies Depression Scale, the Perceived Stress Scale, and the Zarit Burden Interview were administered in person in English or Korean by trained bilingual community health workers. The primary independent variable, acculturation, was assessed using a 24-item inventory. It measured two sets of cultural orientation: Korean orientation and American orientation. The mean age was 67 years (SD = 11.8) and 87% were women. Half of the caregivers were spouses of persons with dementia, while the other half were offspring caregivers. In the multiple linear regression model, caregiver acculturation toward Korean cultural orientation had a significant and positive association with depressive symptoms (β = .62; SE = 0.25; p-value = .02) and perceived stress (β = .29; SE = 0.13; p-value = .03) after adjusting for age and self-efficacy. No significant effect of American cultural orientation was found for caregiver burden, perceived stress, or depressive symptoms. Our findings suggest that exploring the role of acculturation in caregiving and its relation to outcomes, particularly caregiver distress, may be valuable for future studies aiming to understand specific elements of cultural values and practices in the acculturation process related to mental health outcomes among immigrant Korean American caregivers.

A Systematic Review of Educational Interventions for Informal Caregivers of People Living with Dementia in Low and Middle-Income Countries.

Objectives: With the increasing prevalence of dementia worldwide, there is a growing need for an integrated approach to dementia care. Little is known at present about the benefits of educational interventions for informal caregivers of people living with dementia (PLWD) in low- and middle-income countries (LMICs). This review aimed to identify and synthesise the current research on these interventions. Method: Four databases (PsycINFO, Medline, Web of Sciences and Scopus) were searched, alongside Google Scholar and reference lists. The Downs and Black checklist was used for quality assessment and data relating to intervention characteristics, outcomes, and educational component features were compared. Results: Eighteen papers detailing 17 studies were included. All studies presented found at least one significant outcome/effect. Study comparison was difficult due to diverse methodologies, intervention structures, and outcomes. Study quality was also variable. Four studies had education as the primary focus, and most interventions utilised multicomponent and group-based designs. Interventions that included group delivery tended to find more significant results than individual approaches. Intervention length did not appear to influence efficacy. Regular delivery and an average intervention dosage of around 12 h appeared most effective. Conclusions: Research into educational interventions for caregivers in LMICs appears to be promising and can help guide future interventions towards clinical implementation. A multicomponent group intervention trialled in Egypt provided particularly favourable findings. Future studies should focus on understanding the active mechanisms within such interventions to optimize their effectiveness. Collaboration between LMICs, high-income countries (HICs), and caregivers is crucial in developing interventions tailored to meet caregiver needs whilst accounting for feasibility and equity for dementia care worldwide.

Occupational Therapy Interventions for Caregivers of People Who Have Experienced Stroke

Abstract Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Project. Each article in this series summarizes the evidence from published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision-making. In this Evidence Connection article, we provide a case report of a caregiver of a patient who had experienced a stroke. The occupational therapy evaluation and intervention process is described.

Using Digital Inequality Framework to Evaluate a Technology-Delivered Intervention for Caregivers: Age, Education, and Computer Proficiency.

Objectives: Using "digital inequality" as a conceptual framework, this study evaluates the feasibility and usability of a technology-delivered intervention (an "app") for Alzheimer's and related dementia family caregivers. Time for Living and Caring (TLC) is an on-line intervention that provides virtual coaching and self-administered education and resources. Methods: A sample of family caregivers (n = 163) used the tool for 16 weeks, which included completing the Computer Proficiency Questionnaire (CPQ-12) at baseline. Analyses investigate the relationship between age, CPQ scores, intervention use, appraisal, and caregiver outcomes. Results: Age was inversely associated with CPQ; however, CPQ scores did not have a significant relationship with participant's self-perceived benefits or intervention appraisal. Computer Proficiency Questionnaire scores provided insight regarding research feasibility, with lower scores associated with greater odds of discontinuing engagement. Discussion: CPQ-12 scores can be used as a screening tool to identify those who may need additional support to engage with and benefit from technology-delivered interventions.

Health literacy interventions for informal caregivers: systematic review

AimThe aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability.MethodsMEDLINE, CINAHL, PsycINFO and Embase...

First episode psychosis caregiver perspectives on motivational interviewing for loved ones training: A qualitative study.

Past research has found that family involvement in psychosis treatment leads to better patient outcomes. Thus, caregiver communication skills training can be a viable approach to reducing caregiver stress and increasing self-efficacy and communication. The purpose of this qualitative study was to describe family caregivers' perceptions of changes in themselves and their family member with psychosis following their participation in Motivational Interviewing in Loved Ones (MILO), a brief four to five-hour psychoeducational intervention for caregivers. Sixty-three participants in the MILO trials provided written qualitative responses to the prompt, "Since learning the ideas and techniques in this course, what is the most significant change you noticed in yourself, your family, or your relationships?" Responses were collected immediately following MILO participation and 12 weeks later. Qualitative themes were identified through an iterative consensus process. Most participants reported positive changes in multiple domains of their lives. Major themes included: (1) Changes in Self, (2) Changes in Relationships, (3) Changes in Mindset, (4) Use of MILO Skills, and (5) Challenges. Qualitative results support and add context to the previously reported quantitative results from this study. MILO is a promising family intervention that positively influenced family environment and communication in pilot trials. Adaptations of MILO for families outside of a highly educated North American context should be considered.

Promising Impact of Telenovela Intervention for Caregivers of Hospice Patients: A Pilot Study.

Hospice family caregivers (HFCGs) support the needs of their loved ones but are at risk of developing distress and anxiety. NOVELA is a four-chapter telenovela-style educational video to support topics related to hospice caregiving. Telehealth visits are scheduled in 4 weekly sessions consisting of a chapter and subsequent discussion with an interventionist. This feasibility pilot study tested NOVELA's effect to change HFCGs' outcomes, session and outcome measure completion (defined a priori as >70%). This is a single-group pretest-posttest study of HFCGs of care recipients with PPS score >20% from 3 hospices in the U.S. Mid-Atlantic region. At baseline and at final posttest, participants completed a web-based survey assessing 3 outcomes: anxiety, self-efficacy, and satisfaction with intervention. Descriptive, t-test, and chi-square statistics were computed. Participants in our study (N = 59) were mainly collage educated, White, female, adult children of home-bound people with a non-cancer diagnosis. Outcomes changed in the expected direction (P > .05) with higher self-efficacy (Cohen's d = -.08 [95% CI -.4 to .2) and lower anxiety (Cohen's d = .2 [95% CI -.1 to .5]) scores from final to baseline, 86% of HFCGs were satisfied or very satisfied with NOVELA, session (33/59) and outcome measure (43/59) completion averaged 68%. Encouraging trends in NOVELA's estimation of effect suggests that NOVELA may buffer stressful aspects of hospice caregiving. However, further refinement of NOVELA is needed. Supporting HFCGs through supportive educational interventions may reduce distress and anxiety with broad implications for quality improvement.