QOL videoconferencing program may ease caregiver burden

Nearly a decade ago, Mayo Clinic investigators evaluated a structured, multidisciplinary, psychosocial intervention designed to improve quality of life (QOL) among patients with advanced-stage cancer. The findings, which appeared in the February 2006 issue of the Journal of Clinical Oncology, showed improved QOL among patients receiving the intervention and significantly decreased QOL among controls.

Results of a follow-up trial, published in the Feb. 15, 2013, issue of the journal Cancer, found improved QOL among cancer patients participating in the same structured program, which emphasized physical activity, mood management, relaxation training and spirituality. This time, however, cancer caregivers were included in the study, with the hope that they, too, would benefit from the intervention. To the investigators' surprise, the caregivers experienced no significant improvement in QOL, perhaps because the program hadn't been developed for them and they participated only indirectly.

Now, Mayo researchers, led by geriatric psychiatrist and hospice and palliative care specialist Maria I. Lapid, M.D., have undertaken a yearlong pilot study to evaluate the feasibility and acceptability of a technology-based program designed specifically for cancer caregivers.

"There are many reasons to target caregivers," Dr. Lapid says. "We know the burden of people caring for cancer patients is significant. The negative impact of caregiving on caregivers' economic, physical, psychological and social well-being has been extensively studied and well-documented. The good news is there is strong evidence in the literature that caregiver-targeted interventions reduce psychological stress and improve coping and quality of life."

Because the previous interventions were successful in cancer patients, Dr. Lapid's group decided to simply tailor them to meet caregiver needs.

"We offer eight 45-minute sessions, and participants are asked to complete at least six of them," Dr. Lapid explains. "As before, we address all five domains of quality of life: physical, emotional, mental, social and spiritual well-being. But this time, instead of taking place in person, all sessions are conducted online using videoconferencing technology. We feel that accessibility, portability and ease of use makes it easier for caregivers, with their limited time, to participate. We don't want people to worry about the technology; one click of a button and they're connected."

She notes that the Mayo Clinic Center for Innovation provides technology and technical support for the videoconferenced sessions, which can be accessed on any computer or mobile device. Webcams are provided for those who don't have them.

Ultimately, Dr. Lapid hopes to enroll 30 caregivers in the yearlong pilot study; nine are currently participating. Caregivers must be adults caring for recently diagnosed adult cancer patients and have Internet access.

Although researchers aren't looking at data yet, they've made some preliminary observations. One is that caregivers appreciate interacting with one another, even on video. And in spite of occasional technological glitches, videoconferencing seems as effective as in-person group sessions. "It is quite powerful when people start talking about the burden of being a caregiver and how that affects quality of life. It can become very emotional," Dr. Lapid says.

After the pilot phase, investigators will undertake a randomized, controlled trial. Once those results are in, it's hoped that the caregiver intervention, which can be adapted for any illness, will become a clinical service throughout the Mayo system and elsewhere. "There is so much pressure for informal caregivers to take care of their loved ones at home," Dr. Lapid observes, "but nobody pays attention to the caregivers."

For more information

Rummans TA, et al. Impacting quality of life for patients with advanced cancer with a structured, multidisciplinary intervention: A randomized controlled trial. Journal of Clinical Oncology. 2006;24:635.

Clark MM, et al. Randomized controlled trial of maintaining quality of life during radiotherapy for advanced cancer. Cancer. 2013;119:880.

In the Video Center. Mayo Clinic — Cancer caregiver quality of life and burnout. www.mayoclinic.org.