Feasibility of EASE: a psychosocial program to improve symptom management in head and neck cancer patients.

PURPOSE: Head and neck cancer (HNC) patients experience multiple physical and psychosocial symptoms associated with their cancer treatment. The Easing and Alleviating Symptoms during Treatment (EASE) study utilized a mixed methods design to examine the feasibility of a tailored telephone-based coping and stress management intervention to improve symptom management and psychosocial care among HNC patients. METHODS: An Embedded Correlational Mixed Methods Design was utilized to answer two research questions: (1) is the EASE intervention feasible? and (2) Did EASE participants report improvements in psychosocial outcomes after completion of the EASE intervention? HNC patients were assessed at baseline and 3 months. Psychosocial measures included cancer-specific distress, pain, social support, and quality of life. Project records and exit interviews were conducted to assess acceptability and satisfaction with the intervention. RESULTS: The mean age of the participants was 60 years (SD = 9.5), 76 % were male, 47 % married/partnered, and 57 % had a history of tobacco use. Of the 24 participants who were enrolled, 16 completed the intervention. Participants and telephone counselors reported high levels of satisfaction. Although the small sample size and lack of a control group limit our ability to assess the efficacy of the intervention, our findings suggest that the intervention helped to buffer the negative emotional and physical impact of cancer treatment. CONCLUSIONS: This pilot study demonstrated that the EASE intervention is feasible and acceptable to HNC cancer patients undergoing treatment. The study findings revealed some challenges of implementing a psychosocial intervention in HNC patients and inform future intervention studies with this population.

Feasibility of a telephone-based counseling program for informal caregivers of hospice patients.

OBJECTIVES: Informal caregivers of hospice patients experience multiple stressors that can negatively impact physical, psychological, and emotional health. The Caregiver Life Line (CaLL) study was a one-group, intervention-only feasibility study of a telephone cognitive-behavioral stress-management intervention consisting of 10 to 12 weekly telephone counseling calls designed specifically for informal caregivers of home-based hospice patients. METHODS: Caregivers, who were recruited via seven participating hospices, were assessed at baseline, 3, and 6 months. Psychosocial measures included depression, perceived stress, benefit finding, social support, and quality of life (QoL). Process evaluation was also conducted at 6 months. RESULTS: Of the 25 participants, 19 completed the 12-week intervention. The mean age was 60.3 years; 91% were female and 70% married. Forty-eight percent were caring for a spouse; 51% were caring for a parent or other family member. Participating caregivers and hospice staff reported high levels of satisfaction with the intervention. Although the small sample size and lack of a control group limit our ability to assess the efficacy of the intervention, psychosocial outcomes changed in the expected direction and participants reported high levels of self-efficacy regarding their ability to implement the adaptive coping skills. Interestingly, we observed a decrease in physical QoL across the three time points. CONCLUSIONS: This pilot study demonstrated that the CaLL intervention is feasible and acceptable to informal hospice caregivers. This report describes important lessons learned from the pilot study with the intention of informing future intervention studies with this population.

Support needs of informal hospice caregivers: a qualitative study.

BACKGROUND: Informal caregivers of hospice patients experience multiple stressors that can negatively impact physical, psychological, and emotional health. The goal of this qualitative study was to understand caregivers' needs to inform the feasibility, structure, and content of a telephone-based counseling intervention. METHODS: Focus groups and interviews with 36 former hospice caregivers and 11 hospice staff from 6 hospices were conducted. Interviews and focus groups were audio-recorded, transcribed, and analyzed using a constant comparative approach. RESULTS: Key content areas included coping, emotional support, self-care, logistical issues, and bereavement. Respondents supported telephone-based counseling, appreciating its relative anonymity and convenience. It was recommended that calls be initiated by the counselor, on a weekly basis, and that one counselor be assigned to each caregiver. Hospice staff emphasized the need to coordinate telephone counseling with hospice care, scheduling around and communicating with hospice staff. Most caregivers indicated that they would participate in telephone-based counseling were it available; hospice staff thought that half of caregivers would participate. A pervasive theme was that "there can never be enough support for a caregiver." CONCLUSION: Informal caregivers of hospice patients have support needs that are amenable to telephone-based counseling designed to be complementary to existing hospice services. Based on these qualitative findings, we are pilot-testing a telephone-based cognitive-behavioral stress management program for informal caregivers of hospice patients.