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      A systematic review of cancer caregiver interventions: Appraising the potential for implementation of evidence into practice

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          Abstract

          Objective

          nformal caregivers provide substantial support for people living with cancer. Previous systematic reviews report on the efficacy of cancer caregiver interventions but not their potential to be implemented. The aim of this systematic review was to explore the potential for cancer caregiver interventions to be implemented into practice.

          Methods

          We searched three electronic databases to identify cancer caregiver interventions on 5 January 2018. We operationalised six implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and costs) into a tool to guide data extraction.

          Results

          The search yielded 33 papers (27 papers from electronic databases and six papers from other sources) reporting on 26 studies that met review criteria. Fewer than half the studies (46%) contained evidence about the acceptability of interventions from caregivers' perspectives; only two studies (8%) included interventions developed with input from caregivers. Two studies (8%) addressed potential adoption of interventions, and no studies discussed intentions, agreement, or action to implement interventions into practice. All studies reported on intervention appropriateness by providing a rationale for the interventions. For feasibility, on average less than one‐third of caregivers who were eligible to be involved consented to participate. On fidelity, whether interventions were conducted as intended was reported in 62% of studies. Cost data were reported in terms of intervention delivery, requiring a median time commitment of staff of 180 minutes to be delivered.

          Conclusions

          Caregiver intervention studies lack components of study design and reporting that could bridge the gap between research and practice. There is enormous potential for improvements in cancer caregiver intervention study design to plan for future implementation.

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          Most cited references 54

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          Interventions with family caregivers of cancer patients: meta-analysis of randomized trials.

          Family caregivers of cancer patients receive little preparation, information, or support to perform their caregiving role. However, their psychosocial needs must be addressed so they can maintain their own health and provide the best possible care to the patient. The purpose of this article is to analyze the types of interventions offered to family caregivers of cancer patients, and to determine the effect of these interventions on various caregiver outcomes. Meta-analysis was used to analyze data obtained from 29 randomized clinical trials published from 1983 through March 2009. Three types of interventions were offered to caregivers: psychoeducational, skills training, and therapeutic counseling. Most interventions were delivered jointly to patients and caregivers, but they varied considerably with regard to dose and duration. The majority of caregivers were female (64%) and Caucasian (84%), and ranged in age from 18 to 92 years (mean age, 55 years). Meta-analysis indicated that although these interventions had small to medium effects, they significantly reduced caregiver burden, improved caregivers' ability to cope, increased their self-efficacy, and improved aspects of their quality of life. Various intervention characteristics were also examined as potential moderators. Clinicians need to deliver research-tested interventions to help caregivers and patients cope effectively and maintain their quality of life. Copyright 2010 American Cancer Society, Inc.
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            Hidden morbidity in cancer: spouse caregivers.

            This study assesses psychological distress among advanced cancer patients and their spouse caregivers, while examining the relative contribution of caregiving burden and relational variables (attachment orientation and marital satisfaction) to depressive symptoms in the spouse caregivers. A total of 101 patients with advanced GI or lung cancer and their spouse caregivers were recruited for the study. Measures included Beck Depression Inventory-II (BDI-II), Caregiving Burden scale, Experiences in Close Relationships scale, and ENRICH Marital Satisfaction scale. A total of 38.9% of the caregivers reported significant symptoms of depression (BDI-II > or = 15) compared with 23.0% of their ill spouses (P < .0001). In a hierarchical regression predicting caregiver's depression, spouse caregiver's age and patient's cancer site were entered in the first step, objective caregiving burden was entered in the second step, subjective caregiving burden was entered in the third step, caregiver's attachment scores were entered in the fourth step, and caregiver's marital satisfaction score was entered in the fifth step. The final model accounted for 37% of the variance of caregiver depression, with subjective caregiving burden (beta = .38; P < .01), caregiver's anxious attachment (beta = .21; P < .05), caregiver's avoidant attachment (beta = .20; P < .05), and caregiver's marital satisfaction (beta = -.18; P < .05) making significant contributions to the model. Spouse caregivers of patients with advanced cancer are a high-risk population for depression. Subjective caregiving burden and relational variables, such as caregivers' attachment orientations and marital dissatisfaction, are important predictors of caregiver depression.
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              Beginning with the application in mind: designing and planning health behavior change interventions to enhance dissemination.

              Failing to retain an adequate number of study participants in behavioral intervention trials poses a threat to interpretation of study results and its external validity. This qualitative investigation describes the retention strategies promoted by the recruitment and retention committee of the Behavior Change Consortium, a group of 15 university-based sites funded by the National Institutes of Health to implement studies targeted toward disease prevention through behavior change. During biannual meetings, focus groups were conducted with all sites to determine barriers encountered in retaining study participants and strategies employed to address these barriers. All of the retention strategies reported were combined into 8 thematic retention categories. Those categories perceived to be most effective for retaining study participants were summarized and consistencies noted among site populations across the life course (e.g., older adults, adults, children, and adolescents). Further, possible discrepancies between site populations of varying health statuses are discussed, and an ecological framework is proposed for use in future investigations on retention.
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                Author and article information

                Contributors
                a.ugalde@deakin.edu.au
                Journal
                Psychooncology
                Psychooncology
                10.1002/(ISSN)1099-1611
                PON
                Psycho-Oncology
                John Wiley and Sons Inc. (Hoboken )
                1057-9249
                1099-1611
                07 March 2019
                April 2019
                : 28
                : 4 ( doiID: 10.1002/pon.v28.4 )
                : 687-701
                Affiliations
                [ 1 ] School of Nursing and Midwifery Deakin University Geelong Victoria Australia
                [ 2 ] Faculty of Health Deakin University Geelong Victoria Australia
                [ 3 ] Cancer Research Division Cancer Council NSW Sydney New South Wales Australia
                [ 4 ] Department of Psychology Swinburne University Melbourne Victoria Australia
                [ 5 ] Department of Cancer Experiences Research Peter MacCallum Cancer Centre Parkville Victoria Australia
                [ 6 ] Sir Peter MacCallum Department of Oncology University of Melbourne Parkville Victoria Australia
                [ 7 ] Strategy and Support Division Cancer Council Victoria Melbourne Victoria Australia
                [ 8 ] Victorian Comprehensive Cancer Centre Parkville Victoria Australia
                [ 9 ] Cancer Council Australia Sydney New South Wales Australia
                [ 10 ] Faculty of Health University of Technology Sydney Sydney New South Wales Australia
                [ 11 ] Cancer Council QLD Brisbane Queensland Australia
                [ 12 ] Centre for Cancer Research University of Melbourne Parkville Victoria Australia
                Author notes
                [* ] Correspondence

                Anna Ugalde, School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia.

                Email: a.ugalde@ 123456deakin.edu.au

                Article
                PON5018 PON-18-0661.R1
                10.1002/pon.5018
                6594143
                30716183
                © 2019 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 1, Tables: 2, Pages: 15, Words: 4128
                Product
                Funding
                Funded by: Victorian Cancer Agency Early Career Seed Grant
                Award ID: ECSG14037
                Categories
                Review
                Reviews
                Custom metadata
                2.0
                pon5018
                April 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:26.06.2019

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