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Improving depressive symptoms among caregivers of patients with cancer: results of a randomized clinical trial.

PURPOSE/OBJECTIVES
Determine the impact of a 16-week supportive nursing intervention on caregivers of patients with newly diagnosed cancer.


DESIGN
Randomized clinical trial.


SETTING
Two midwestern cancer treatment sites.


SAMPLE
Caregivers of newly diagnosed patients. Patients' mean age was 55.73 years; 55% had breast cancer, and 76% were female. Caregivers' mean age was 52.44 years, and 50% were female. 125 dyads consented to participate; 89 dyads completed the study.


METHODS
A nursing intervention was delivered to the experimental group that emphasized symptom monitoring/management, education, emotional support, coordination of services, and caregiver preparation to care. Nurses made a total of nine contacts, five in person and four by telephone, over 16 weeks. Centers for Epidemiological Studies-Depression (CES-D) and a symptom inventory were used. Medical record audits were conducted retrospectively.


MAIN RESEARCH VARIABLES
Patient and caregiver depression scores and patient symptom experience.


FINDINGS
Baseline caregiver depression and the number of patient symptoms at baseline, 9, and 24 weeks were significant predictors of caregiver depression at 9 and 24 weeks. However, no main effect of the experimental condition existed on caregiver depression. At the final observation, a nonsignificant inverse relationship was found between the number of interventions and depression scores for caregivers.


CONCLUSIONS
The intervention appeared to be more effective in slowing the rate of deterioration of depressive symptoms than in decreasing levels of depression in this sample of caregivers. Determining the effectiveness of this intervention in decreasing caregiver depression was difficult because caregivers with higher levels of depression were more likely to withdraw from the study.


IMPLICATIONS FOR NURSING PRACTICE
Nurses must be vigilant in monitoring caregivers for signs of depression and must intervene to provide emotional support and make appropriate referrals for follow-up care to promote positive outcomes for patients and caregivers.