Psychoeducational Interventions for Caregivers of Persons With Multiple Sclerosis: Protocol for a Randomized Trial

Sara L Douglas, Matthew Plow, Tanya Packer, Amy R Lipson, Michelle J Lehman, Sara L Douglas, Matthew Plow, Tanya Packer, Amy R Lipson, Michelle J Lehman

Abstract

Background: Of the approximately 1 million people living with multiple sclerosis in the United States, more than half receive informal, unpaid care or support from family or friends (caregivers). These caregivers report high levels of stress, anxiety, and negative emotions. Few researchers have conducted psychoeducational interventions for these caregivers.

Objective: This paper presents a protocol for a randomized clinical trial that aims to test the efficacy of two interventions for improving stress, anxiety, depression, and negative emotions for caregivers of persons with multiple sclerosis.

Methods: Participants included any self-identified family or friend caregiver of a person with multiple sclerosis. Data collection began in April 2021 and is expected to continue until November 2021. Participants will be randomized to receive either a website-only or a website-coaching intervention delivered for 6 weeks. Data will be collected at baseline, 6 weeks after baseline (after delivery of intervention), and 6 weeks later.

Results: The protocol was approved by the institutional review board of the Case Western Reserve University on January 21, 2021 (protocol 20201484). As of May 2021, 66 participants were enrolled.

Conclusions: Our findings will have implications for identifying the efficacy of two types of interventions developed for caregivers of persons with multiple sclerosis to reduce negative psychological outcomes associated with caregiving.

Trial registration: ClinicalTrials.gov NCT04662008; https://ichgcp.net/clinical-trials-registry/NCT04662008.

International registered report identifier (irrid): DERR1-10.2196/30617.

Keywords: anxiety; caregivers; coaching; depression; distress; mobile phone; multiple sclerosis; psycho-education; website.

Conflict of interest statement

Conflicts of Interest: None declared.

©Sara L Douglas, Matthew Plow, Tanya Packer, Amy R Lipson, Michelle J Lehman. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 26.08.2021.

Figures

Figure 1
Figure 1
Homepage for the “caring for yourself” module from the study website.
Figure 2
Figure 2
Frequently asked questions for the “caring for yourself” module from the study website.

References

    1. Wallin MT, Culpepper WJ, Campbell JD, Nelson LM, Langer-Gould A, Marrie RA, Cutter GR, Kaye WE, Wagner L, Tremlett H, Buka SL, Dilokthornsakul P, Topol B, Chen LH, LaRocca NG, US Multiple Sclerosis Prevalence Workgroup The prevalence of MS in the United States: A population-based estimate using health claims data. Neurology. 2019 Mar 05;92(10):e1029–e1040. doi: 10.1212/WNL.0000000000007035. WNL.0000000000007035
    1. Kobelt G, Thompson A, Berg J, Gannedahl M, Eriksson J, MSCOI Study Group. European Multiple Sclerosis Platform New insights into the burden and costs of multiple sclerosis in Europe. Mult Scler. 2017 Jul;23(8):1123–36. doi: 10.1177/1352458517694432.
    1. Hategeka C, Traboulsee A, McMullen K, Lynd L. Stigma in multiple sclerosis: association with work productivity loss, health related quality of life and caregivers' burden. American Academy of Neurology. 2017. [2021-08-03]. .
    1. Bayen E, Papeix C, Pradat-Diehl P, Lubetzki C, Joël ME. Patterns of objective and subjective burden of informal caregivers in multiple sclerosis. Behav Neurol. 2015;2015:1–10. doi: 10.1155/2015/648415. doi: 10.1155/2015/648415.
    1. Maguire R, Maguire P. Caregiver burden in multiple sclerosis: recent trends and future directions. Curr Neurol Neurosci Rep. 2020 May 22;20(7):18. doi: 10.1007/s11910-020-01043-5. 10.1007/s11910-020-01043-5
    1. Topcu G, Buchanan H, Aubeeluck A, Garip G. Caregiving in multiple sclerosis and quality of life: a meta-synthesis of qualitative research. Psychol Health. 2016 Jun 09;31(6):693–710. doi: 10.1080/08870446.2016.1139112.
    1. Bassi M, Cilia S, Falautano M, Grobberio M, Negri L, Niccolai C, Pattini M, Pietrolongo E, Quartuccio ME, Viterbo RG, Allegri B, Amato MP, Benin M, De Luca G, Gasperini C, Minacapelli E, Patti F, Trojano M, Delle Fave A. The caring experience in multiple sclerosis: caregiving tasks, coping strategies and psychological well-being. Health Soc Care Community. 2020 Jan 16;28(1):236–46. doi: 10.1111/hsc.12858.
    1. Wawrziczny E, Corrairie A, Antoine P. Relapsing-remitting multiple sclerosis: an interpretative phenomenological analysis of dyadic dynamics. Disabil Rehabil. 2021 Jan 26;43(1):76–84. doi: 10.1080/09638288.2019.1617794.
    1. Dayapoğlu N, Tan M. The care burden and social support levels of caregivers of patients with multiple sclerosis. Kontakt. 2017 Mar 28;19(1):17–23. doi: 10.1016/j.kontakt.2016.12.001.
    1. Sullivan AB, Miller D. Who is taking care of the caregiver? J Patient Exp. 2015 May 01;2(1):7–12. doi: 10.1177/237437431500200103. 10.1177_237437431500200103
    1. Verbakel E, Tamlagsrønning S, Winstone L, Fjær L, Eikemo T. Informal care in Europe: findings from the European Social Survey (2014) special module on the social determinants of health. Eur J Public Health. 2017 Feb 01;27(suppl_1):90–5. doi: 10.1093/eurpub/ckw229.3045950
    1. Gately M, Ladin K. Family and other caregivers. In: Daaleman T, Helton M, editors. Chronic Illness Care. Cham: Springer; 2018. pp. 111–20.
    1. Opara J, Brola W. Quality of life and burden in caregivers of multiple sclerosis patients. Physiother Health Act. 2018;25:16. doi: 10.1515/pha-2017-0002.
    1. Giordano A, Cimino V, Campanella A, Morone G, Fusco A, Farinotti M, Palmisano L, Confalonieri P, Lugaresi A, Grasso MG, Ponzio M, Veronese S, Patti F, Solari A, PeNSAMI project Low quality of life and psychological wellbeing contrast with moderate perceived burden in carers of people with severe multiple sclerosis. J Neurol Sci. 2016 Jul 15;366:139–45. doi: 10.1016/j.jns.2016.05.016.S0022-510X(16)30275-1
    1. Petrikis P, Baldouma A, Katsanos AH, Konitsiotis S, Giannopoulos S. Quality of life and emotional strain in caregivers of patients with multiple sclerosis. J Clin Neurol. 2019 Jan;15(1):77–83. doi: 10.3988/jcn.2019.15.1.77. 15.77
    1. Pooyania S, Lobchuk M, Chernomas W, Marrie R. Examining the relationship between family caregivers' emotional states and ability to empathize with patients with multiple sclerosis: a pilot study. Int J MS Care. 2016;18(3):122–8. doi: 10.7224/1537-2073.2015-023.
    1. Figved N, Myhr K, Larsen J, Aarsland D. Caregiver burden in multiple sclerosis: the impact of neuropsychiatric symptoms. J Neurol Neurosurg Psychiatry. 2007 Oct 01;78(10):1097–102. doi: 10.1136/jnnp.2006.104216. jnnp.2006.104216
    1. McKenzie T, Quig M, Tyry T, Marrie R, Cutter G, Shearin E, Johnson K, Simsarian J. Care partners and multiple sclerosis: differential effect on men and women. Int J MS Care. 2015;17(6):253–60. doi: 10.7224/1537-2073.2014-083.
    1. Santos M, Sousa C, Pereira M, Pereira MG. Quality of life in patients with multiple sclerosis: a study with patients and caregivers. Disabil Health J. 2019 Oct;12(4):628–34. doi: 10.1016/j.dhjo.2019.03.007.S1936-6574(19)30052-4
    1. Grimby A. Anticipatory grief among close relatives of patients with ALS and MS. Psychol Behav Sci. 2015;4(3):125. doi: 10.11648/j.pbs.20150403.16.
    1. Algahtani H, Shirah B, Bayazeed A, Alghamdi A, Almailabi M, Algharib M, Alkahtani F. Assessment of the burden of multiple sclerosis patients' caregivers in Saudi Arabia. Cureus. 2020 Jan 14;12(1):e6658. doi: 10.7759/cureus.6658.
    1. Tramonti F, Bonfiglio L, Bongioanni P, Belviso C, Fanciullacci C, Rossi B, Chisari C, Carboncini MC. Caregiver burden and family functioning in different neurological diseases. Psychol Health Med. 2019 Jan 24;24(1):27–34. doi: 10.1080/13548506.2018.1510131.
    1. Pahlavanzadeh S, Dalvi-Isfahani F, Alimohammadi N, Chitsaz A. The effect of group psycho-education program on the burden of family caregivers with multiple sclerosis patients in Isfahan in 2013-2014. Iran J Nurs Midwifery Res. 2015;20(4):420–5. doi: 10.4103/1735-9066.161000. IJNMR-20-420
    1. Navidian A, Rezaee N, Baniasadi F, Shakiba M. Effect of a couples' relationship enrichment program on the quality of marital relationships from the perspective of spouses of patients with multiple sclerosis. Issues Ment Health Nurs. 2017 Sep 29;38(9):756–62. doi: 10.1080/01612840.2017.1294221.
    1. Tompkins S, Roeder J, Thomas J, Koch K. Effectiveness of a relationship enrichment program for couples living with multiple sclerosis. Int J MS Care. 2013;15(1):27–34. doi: 10.7224/1537-2073.2012-002.
    1. Badr H, Carmack CL, Diefenbach MA. Psychosocial interventions for patients and caregivers in the age of new communication technologies: opportunities and challenges in cancer care. J Health Commun. 2015;20(3):328–42. doi: 10.1080/10810730.2014.965369.
    1. DuBenske LL, Gustafson DH, Namkoong K, Hawkins RP, Atwood AK, Brown RL, Chih M, McTavish F, Carmack CL, Buss MK, Govindan R, Cleary JF. CHESS improves cancer caregivers' burden and mood: results of an eHealth RCT. Health Psychol. 2014 Oct;33(10):1261–72. doi: 10.1037/a0034216. 2013-39991-001
    1. Hodges L, Humphris G, Macfarlane G. A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Soc Sci Med. 2005 Jan;60(1):1–12. doi: 10.1016/j.socscimed.2004.04.018.S0277953604001984
    1. Northouse L, Schafenacker A, Barr KL, Katapodi M, Yoon H, Brittain K, Song L, Ronis DL, An L. A tailored web-based psychoeducational intervention for cancer patients and their family caregivers. Cancer Nurs. 2014;37(5):321–30. doi: 10.1097/NCC.0000000000000159.
    1. Northouse LL, Mood D, Templin T, Mellon S, George T. Couples' patterns of adjustment to colon cancer. Soc Sci Med. 2000 Jan;50(2):271–84. doi: 10.1016/s0277-9536(99)00281-6.
    1. Douglas SL, Mazanec P, Lipson AR, Day K, Blackstone E, Bajor DL, Saltzman J, Krishnamurthi S. Videoconference intervention for distance caregivers of patients with cancer: a randomized controlled trial. JCO Oncology Practice. 2021 Jan;17(1):26–35. doi: 10.1200/op.20.00576.
    1. Rakhshan M, Ganjalivand S, Zarshenas L, Majdinasab N. The effect of collaborative care model-based intervention on hope in caregivers and patients with multiple sclerosis: a randomized controlled clinical trial. Int J Community Based Nurs Midwifery. 2018 Jul;6(3):218–26.
    1. Jafari Y, Tehrani H, Esmaily H, Shariati M, Vahedian-Shahroodi M. Family-centred empowerment program for health literacy and self-efficacy in family caregivers of patients with multiple sclerosis. Scand J Caring Sci. 2020 Dec 27;34(4):956–63. doi: 10.1111/scs.12803.
    1. Khazaeili M, Hajebi M, Mohamadkhani P, Mirzahoseini H. The effectiveness of mindfulness-based intervention on anxiety, depression and burden of caregivers of multiple sclerosis patients through web conferencing. Pract Clin Psychol. 2019 Jan 30;:21–32. doi: 10.32598/jpcp.7.1.21.
    1. Martindale-Adams J, Zuber J, Levin M, Burns R, Graney M, Nichols LO. Integrating caregiver support into multiple sclerosis care. Mult Scler Int. 2020 Jan 27;2020:1–8. doi: 10.1155/2020/3436726.
    1. Northouse L, Williams A, Given B, McCorkle R. Psychosocial care for family caregivers of patients with cancer. J Clin Oncol. 2012 Apr 10;30(11):1227–34. doi: 10.1200/JCO.2011.39.5798.
    1. Northouse LL, Katapodi MC, Song L, Zhang L, Mood DW. Interventions with family caregivers of cancer patients: meta-analysis of randomized trials. CA Cancer J Clin. 2010 Aug;60(5):317–39. doi: 10.3322/caac.20081. doi: 10.3322/caac.20081.caac.20081
    1. Kamen C, Mustian KM, Heckler C, Janelsins MC, Peppone LJ, Mohile S, McMahon JM, Lord R, Flynn PJ, Weiss M, Spiegel D, Morrow GR. The association between partner support and psychological distress among prostate cancer survivors in a nationwide study. J Cancer Surviv. 2015 Sep 21;9(3):492–9. doi: 10.1007/s11764-015-0425-3.
    1. Kravits K, McAllister-Black R, Grant M, Kirk C. Self-care strategies for nurses: a psycho-educational intervention for stress reduction and the prevention of burnout. Appl Nurs Res. 2010 Aug;23(3):130–8. doi: 10.1016/j.apnr.2008.08.002.S0897-1897(08)00082-7
    1. Jones R, Thapar A, Rice F, Beeching H, Cichosz R, Mars B, Smith DJ, Merry S, Stallard P, Jones I, Thapar AK, Simpson SA. A web-based psychoeducational intervention for adolescent depression: design and development of MoodHwb. JMIR Ment Health. 2018 Feb 15;5(1):e13. doi: 10.2196/mental.8894. v5i1e13
    1. Wang Y, Lin Y, Chen J, Wang C, Hu R, Wu Y. Effects of internet-based psycho-educational interventions on mental health and quality of life among cancer patients: a systematic review and meta-analysis. Support Care Cancer. 2020 Jun 16;28(6):2541–52. doi: 10.1007/s00520-020-05383-3.10.1007/s00520-020-05383-3
    1. Bártolo A, Pacheco E, Rodrigues F, Pereira A, Monteiro S, Santos IM. Effectiveness of psycho-educational interventions with telecommunication technologies on emotional distress and quality of life of adult cancer patients: a systematic review. Disabil Rehabil. 2019 Apr 07;41(8):870–8. doi: 10.1080/09638288.2017.1411534.
    1. Crisp D, Griffiths K, Mackinnon A, Bennett K, Christensen H. An online intervention for reducing depressive symptoms: secondary benefits for self-esteem, empowerment and quality of life. Psychiatry Res. 2014 Apr 30;216(1):60–6. doi: 10.1016/j.psychres.2014.01.041.S0165-1781(14)00082-1
    1. Wittenberg E, Ferrell B, Koczywas M, Del Ferraro C, Ruel NH. Pilot study of a communication coaching telephone intervention for lung cancer caregivers. Cancer Nurs. 2018;41(6):506–12. doi: 10.1097/ncc.0000000000000535.
    1. Milbury K, Li Y, Durrani S, Liao Z, Tsao AS, Carmack C, Cohen L, Bruera E. A mindfulness-based intervention as a supportive care strategy for patients with metastatic non-small cell lung cancer and their spouses: results of a three-arm pilot randomized controlled trial. Oncologist. 2020 Nov 17;25(11):1794–802. doi: 10.1634/theoncologist.2020-0125. doi: 10.1634/theoncologist.2020-0125.
    1. Low JK, Manias E. Use of technology-based tools to support adolescents and young adults with chronic disease: systematic review and meta-analysis. JMIR Mhealth Uhealth. 2019 Jul 18;7(7):e12042. doi: 10.2196/12042. v7i7e12042
    1. Canter KS, Christofferson J, Scialla MA, Kazak AE. Technology-focused family interventions in pediatric chronic illness: a systematic review. J Clin Psychol Med Settings. 2019 Mar 20;26(1):68–87. doi: 10.1007/s10880-018-9565-8.10.1007/s10880-018-9565-8
    1. Sood A, Watts SA, Johnson JK, Hirth S, Aron DC. Telemedicine consultation for patients with diabetes mellitus: a cluster randomised controlled trial. J Telemed Telecare. 2018 Jul;24(6):385–391. doi: 10.1177/1357633X17704346.
    1. Blackstone E, Lipson AR, Douglas SL. Closer: A videoconference intervention for distance caregivers of cancer patients. Res Nurs Health. 2019 Aug 22;42(4):256–63. doi: 10.1002/nur.21952.
    1. Yates ME, Tennstedt S, Chang B. Contributors to and mediators of psychological well-being for informal caregivers. J Gerontol B Psychol Sci Soc Sci. 1999 Jan;54(1):P12–22. doi: 10.1093/geronb/54b.1.p12.
    1. Litzelman K, Kent EE, Mollica M, Rowland JH. How does caregiver well-being relate to perceived quality of care in patients with cancer? Exploring associations and pathways. J Clin Oncol. 2016 Oct 10;34(29):3554–3561. doi: 10.1200/JCO.2016.67.3434. JCO.2016.67.3434
    1. Lee Y, Liao Y, Shun S, Lin K, Liao W, Chang P, Jhang S, Yu C, Yang P, Hsieh P, Lai Y. Trajectories of caregiver burden and related factors in family caregivers of patients with lung cancer. Psychooncology. 2018 Jun 30;27(6):1493–500. doi: 10.1002/pon.4678.
    1. Khan F, Pallant J, Brand C. Caregiver strain and factors associated with caregiver self-efficacy and quality of life in a community cohort with multiple sclerosis. Disabil Rehabil. 2007 Aug 30;29(16):1241–50. doi: 10.1080/01443610600964141.780761964
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81. doi: 10.1016/j.jbi.2008.08.010. S1532-0464(08)00122-6
    1. Vloothuis J, Mulder M, Nijland RH, Goedhart QS, Konijnenbelt M, Mulder H, Hertogh CM, van Tulder M, van Wegen EE, Kwakkel G. Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): study protocol for a randomized controlled trial. BMC Neurol. 2015 Oct 09;15(1):193. doi: 10.1186/s12883-015-0440-z. 10.1186/s12883-015-0440-z
    1. Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics. 1975 Mar;31(1):103–15.
    1. Minimran: a robust online system to implement minimization in randomized clinical trials. Sutter Health. [2021-06-14]. .
    1. Health information privacy. Health and Human Services. [2021-06-21]. .
    1. The Personal Information Protection and Electronic Documents Act (PIPEDA) Office of the Privacy Commissioner of Canada. [2021-06-21].
    1. Mohr DC, Schueller SM, Montague E, Burns MN, Rashidi P. The behavioral intervention technology model: an integrated conceptual and technological framework for eHealth and mHealth interventions. J Med Internet Res. 2014 Jun;16(6):e146. doi: 10.2196/jmir.3077. v16i6e146
    1. Clear communication. National Institutes of Health. [2021-06-15]. .
    1. Health Education Materials Assessment Tool. National Library of Medicine. [2021-06-15]. .
    1. Borson S, Mobley P, Fernstrom K, Bingham P, Sadak T, Britt HR. Measuring caregiver activation to identify coaching and support needs: extending MYLOH to advanced chronic illness. PLoS One. 2018 Oct 11;13(10):e0205153. doi: 10.1371/journal.pone.0205153. PONE-D-17-08586
    1. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Hoboken, New Jersey, United States: Prentice Hall; 1985. pp. 1–640.
    1. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215. doi: 10.1037/0033-295X.84.2.191.
    1. Park S. Caregivers' mental health and somatic symptoms during COVID-19. J Gerontol B Psychol Sci Soc Sci. 2021 Mar 14;76(4):235–40. doi: 10.1093/geronb/gbaa121. 5879757
    1. Case Western Reserve University Zoom. [2021-06-16]. .
    1. Smyth JM, Johnson JA, Auer BJ, Lehman E, Talamo G, Sciamanna CN. Online positive affect journaling in the improvement of mental distress and well-being in general medical patients with elevated anxiety symptoms: a preliminary randomized controlled trial. JMIR Ment Health. 2018 Dec 10;5(4):e11290. doi: 10.2196/11290. v5i4e11290
    1. Hedeker D, Gibbons RD, Waternaux C. Sample size estimation for longitudinal designs with attrition: comparing time-related contrasts between two groups. J Edu Behav Stat. 2016 Aug 26;24(1):70–93. doi: 10.3102/10769986024001070.
    1. Lee AC, Driban JB, Price LL, Harvey WF, Rodday AM, Wang C. Responsiveness and minimally important differences for 4 patient-reported outcomes measurement information system short forms: physical function, pain interference, depression, and anxiety in knee osteoarthritis. J Pain. 2017 Sep;18(9):1096–110. doi: 10.1016/j.jpain.2017.05.001. S1526-5900(17)30571-0
    1. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998 Jun;10(2):176–81. doi: 10.1037/1040-3590.10.2.176.
    1. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai J, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. 2010 Nov;63(11):1179–94. doi: 10.1016/j.jclinepi.2010.04.011. S0895-4356(10)00173-3
    1. Schalet BD, Cook KF, Choi SW, Cella D. Establishing a common metric for self-reported anxiety: linking the MASQ, PANAS, and GAD-7 to PROMIS Anxiety. J Anxiety Disord. 2014 Jan;28(1):88–96. doi: 10.1016/j.janxdis.2013.11.006. S0887-6185(13)00215-6
    1. Zwahlen D, Hagenbuch N, Carley MI, Recklitis CJ, Buchi S. Screening cancer patients' families with the distress thermometer (DT): a validation study. Psychooncology. 2008 Oct;17(10):959–66. doi: 10.1002/pon.1320.
    1. Cutillo A, O'Hea Erin, Person S, Lessard D, Harralson T, Boudreaux E. The distress thermometer: cutoff points and clinical use. Oncol Nurs Forum. 2017 May 01;44(3):329–336. doi: 10.1188/17.ONF.329-336.
    1. Rajeshwari A, Revathi R, Prasad N, Michelle N. Assessment of distress among patients and primary caregivers: findings from a chemotherapy outpatient unit. Indian J Palliat Care. 2020;26(1):42–46. doi: 10.4103/IJPC.IJPC_163_19. IJPC-26-42
    1. Douglas SL, Daly BJ. Effect of an integrated cancer support team on caregiver satisfaction with end-of-life care. Oncol Nurs Forum. 2014 Jul 01;41(4):E248–55. doi: 10.1188/14.ONF.E248-E255. J7H841270423P330
    1. National Multiple Sclerosis Society. [2021-06-15]. .

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