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An Individualized Dyadic Problem-Solving Education Intervention for Patients and Family Caregivers During Allogeneic Hematopoietic Stem Cell Transplantation: A Feasibility Study

Bevans, Margaret RN, PhD, AOCN; Castro, Kathleen RN, MSN, AOCN; Prince, Patricia M.Ed., LICSW; Shelburne, Nonniekaye CRNP, MS, AOCN; Prachenko, Olena MA; Loscalzo, Matthew MSW; Soeken, Karen PhD; Zabora, James ScD

doi: 10.1097/NCC.0b013e3181be5e6d
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Background: Allogeneic hematopoietic stem cell transplantation (HSCT) generates multiple problems that vary in complexity and create significant distress for both patients and their caregivers. Interventions that address patient and family caregiver distress during allogeneic hematopoietic stem cell transplantation (HSCT) have not been tested.

Objective: To evaluate the feasibility of conducting an individualized dyadic problem-solving education (PSE) intervention during HSCT and estimate a preliminary effect size on problem-solving skills and distress.

Methods: The PSE intervention consisted of 4 sessions of the Prepared Family Caregiver PSE model. Data were collected with an interventionist log, subject interviews and standardized questionnaires.

Results: Of the 34 adult dyads screened, 24 were ineligible primarily because of being non-English-speaking (n = 11) and inconsistent caregivers (n = 10). Ten dyads (n = 20) were enrolled, and 8 dyads (n = 16) completed the intervention. Of the 31 sessions, 29 were completed (94%). Worsening patient condition was the primary reason for sessions to be incomplete. Patients attended 90% of the sessions; caregivers attended 74%. Reasons for missed sessions included patient symptom distress and limited caregiver availability. Dyads reported being very satisfied (mean, 4.8 [SD, 1.8]; range, 1-5), stating "an opportunity to talk" and "creative thinking" were most beneficial.

Conclusion: Results suggest that dyads can participate in PSE during HSCT and view it as beneficial. Participants identified the active process of solving problems as helpful.

Implications for Practice: Targeted interventions that promote effective, meaningful behaviors are needed to guide patients and caregivers through HSCT. Future research recommendations include testing a version of PSE with fewer sessions, including spousal and nonspousal caregivers and those who are non-English speaking.

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) generates multiple problems that vary in complexity and create significant distress for both patients and their caregivers. Interventions that address patient and family caregiver distress during allogeneic hematopoietic stem cell transplantation (HSCT) have not been tested. Objective: To evaluate the feasibility of conducting an individualized dyadic problem-solving education (PSE) intervention during HSCT and estimate a preliminary effect size on problem-solving skills and distress. Methods: The PSE intervention consisted of 4 sessions of the Prepared Family Caregiver PSE model. Data were collected with an interventionist log, subject interviews and standardized questionnaires. Results: Of the 34 adult dyads screened, 24 were ineligible primarily because of being non-English-speaking (n = 11) and inconsistent caregivers (n = 10). Ten dyads (n = 20) were enrolled, and 8 dyads (n = 16) completed the intervention. Of the 31 sessions, 29 were completed (94%). Worsening patient condition was the primary reason for sessions to be incomplete. Patients attended 90% of the sessions; caregivers attended 74%. Reasons for missed sessions included patient symptom distress and limited caregiver availability. Dyads reported being very satisfied (mean, 4.8 [SD, 1.8]; range, 1-5), stating "an opportunity to talk" and "creative thinking" were most beneficial. Conclusion: Results suggest that dyads can participate in PSE during HSCT and view it as beneficial. Participants identified the active process of solving problems as helpful. Implications for Practice: Targeted interventions that promote effective, meaningful behaviors are needed to guide patients and caregivers through HSCT. Future research recommendations include testing a version of PSE with fewer sessions, including spousal and nonspousal caregivers and those who are non-English speaking.

Authors' Affiliations: National Institutes of Health, Bethesda, Maryland (Dr Bevans, Mss Castro, Prince, Shelburne, and Prachenko); City of Hope, Duarte, California (Mr Loscalzo); and National Catholic School of Social Service, Washington, DC (Dr Zabora).

Dr Soeken, Professor Emeritus, University of Maryland School of Nursing, Baltimore.

This study was funded by the Intramural Research Program of the National Institutes of Health, Clinical Center.

Corresponding author: Margaret Bevans, RN, PhD, AOCN, 5061 Durham Rd W, Columbia, MD 21044 (mbevans@cc.nih.gov).

Accepted for publication August 27, 2009.

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