Family Caregivers, Stroke
Conditions
Keywords
Clinical trial
Brief summary
Caring for a family member after a stroke can be very difficult and worsen the physical and mental health of untrained caregivers. The Telephone Assessment and Skill-Building Kit (TASK III) intervention is a unique, comprehensive caregiver intervention program that enables caregivers to develop the necessary skills to manage care for the survivor, while also taking care of themselves. The long-term goal of this study is to offer training and support for family caregivers through an efficacious, cost-effective program.
Detailed description
Stroke is a leading cause of serious, long-term disability, and has a very sudden onset; families are often thrust into providing care without any training from health care providers. Studies have shown that caregiving without training can be detrimental to caregiver's physical and mental health, which can impede survivor rehabilitation and lead to institutionalization and higher societal costs. Unlike existing stroke caregiver interventions that require costly face to face interactions, and that focus primarily on the survivor's care, the Telephone Assessment and Skill-Building Kit (TASK II) is delivered completely by telephone, and empowers caregivers to address both their own and the survivor's needs using innovative skill-building strategies. Aligned with current patient and caregiver guidelines, TASK II has demonstrated evidence of content validity, treatment fidelity, caregiver satisfaction, and efficacy for reducing depressive symptoms; however, future development of TASK II requires a stronger focus on self-management strategies to improve caregiver health, and enhanced use of other telehealth modes of delivery prior to implementation into ongoing stroke systems of care. The purpose of this study is to optimize the TASK III intervention through the innovative leveraging of technologies and theoretically-based self-management strategies to improve caregiver health. Specific Aim 1 consists of focus groups and individual interviews with 40 experts (10 interdisciplinary researchers, 10 technology experts, 10 clinicians and clinical leaders, and 10 stroke family caregivers) to provide preferences about essential areas of new self-management content, proposed technologies (e.g., iBook, eBook, interactive website, FaceTime, Zoom), and future implementation strategies to inform a novel TASK III prototype. Specific Aim 2 will determine feasibility of the TASK III intervention with a pilot study of 74 stroke caregivers randomized to TASK III or an Information, Support, and Referral (ISR) group in preparation for a larger randomized controlled clinical trial. Recruitment, retention, treatment fidelity, satisfaction, and technology ratings will be obtained for both TASK III and ISR groups who will receive 8 weekly sessions with a booster session 4 weeks later. Outcome measures will be explored at baseline, 8 weeks (end of intervention), and 12 weeks (after booster). If TASK III is shown to be efficacious in a future randomized controlled clinical trial, our next goal will be to translate TASK III into ongoing stroke systems of care; and, someday to adapt it for use among caregivers with other debilitating/chronic conditions providing a tremendous public health impact.
Interventions
BEHAVIORALTelephone Assessment and Skill-Building Kit (TASK III) Group
The TASK III group will receive a TASK III Resource Guide that we developed and 8 weekly calls from a nurse. The nurse will call again a month later. The TASK III nurse will help you assess your needs and concerns, build your skills as a caregiver, and refer you to community resources.
The ISR group will receive an American Heart Association brochure and 8 weekly calls from a nurse. The nurse will call again a month later. The ISR nurse will provide information, support, and referral to community resources.
Sponsors
National Institute of Nursing Research (NINR)
University of Cincinnati
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* 21 years or older * Primary caregiver (unpaid family member or significant other providing care for a stroke survivor) * Must be providing care after discharge to the home setting (for Specific Aim 2) * Fluent in the English language * Access to telephone or computer * No difficulties hearing or talking by telephone or computer * (Specific Aim 1) Willing to participate in an online or telephone focus group or an online or telephone individual interview. Some interviews or focus groups may be offered face to face. * (Specific Aim 2) Willing to participate in 9 calls from a nurse and 3 data collection interviews.
Exclusion criteria
Excluded if the survivor: * Had not had a stroke * Did not need help from the caregiver * Was going to reside in a nursing home or long-term care facility Excluded if the caregiver: * Scores \<16 on the Oberst Caregiving Burden Scale Task Difficulty Subscale (for Specific Aim 2) * Scores \< 4 on a 6-item cognitive impairment screener. Excluded if the caregiver or survivor is: * Prisoner or on house arrest * Pregnant * Terminal illness (e.g., late stage cancer, end-of-life condition, renal failure requiring dialysis) * History of Alzheimer's, dementia, or severe mental illness (e.g., suicidal tendencies, schizophrenia, severe untreated depression or manic depressive disorder) * History of hospitalization for alcohol or drug abuse
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Caregiver Satisfaction Ratings for Both TASK III and ISR Programs Measured by the Caregiver Satisfaction Scale (CSS). | 12 weeks | Caregiver satisfaction ratings (usability, ease of use, acceptability) for both TASK III and ISR programs are measured using the Caregiver Satisfaction Scale (CSS). The CSS consists of 9 items rated on a response scale ranging from 1 = Strongly Disagree to 5 = Strongly Agree. Items are summed for a total score, then divided by 9 (number of items) with a possible range of 1 to 5. Higher scores indicate greater satisfaction. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Depressive Symptoms Measured by the Patient Health Questionnaire Depression Scale (PHQ-9). | Assessed at Baseline, Week 8, and Week 12, change from Baseline to Week 8 Reported. | Caregiver depressive symptoms are measured by the Patient Health Questionnaire Depression Scale (PHQ-9) consisting of 9 items rated on a response scale ranging from 0 = Not at all to 3 = Nearly every day. Items are summed for a total score with a possible range of 0 to 27. Higher scores indicate higher depressive symptoms. |
| Life Changes (i.e., Changes in Social Functioning, Subjective Well-being, and Physical Health as a Result of Providing Care) Measured by the Bakas Caregiving Outcomes Scale (BCOS). | Assessed at Baseline, Week 8, and Week 12, change from Baseline to Week 8 Reported. | Caregiver life changes (i.e., changes in social functioning, subjective well-being, and physical health as a result of providing care) are measured by the Bakas Caregiving Outcomes Scale (BCOS). The BCOS consists of 15 items rated on a response scale ranging from -3 (changed for the worst) to +3 (Changed for the best). The items are recoded (-3 = 1) (-2 = 2) (-1 = 3) (0 = 4) (1 = 5) (2 = 6) (3 = 7) so that positive numbers can be obtained for analysis. The recoded responses to the 15 items are summed for a total score with a possible range of 15-105. Higher scores indicate more positive life changes as a result of providing care. |
| Unhealthy Days Measured by the Number of Unhealthy Days in the Past 30 Days. | Assessed at Baseline, Week 8, and Week 12, change from Baseline to Week 8 Reported. | Caregiver unhealthy days are measured using the Unhealthy Days (UD) measure consisting of two items: How many days during the past 30 days was your physical health not good?; How many days during the past 30 days was your mental health not good? These items range from 0 = no unhealthy days to 30 = 30 unhealthy days. The two items are summed for a total score, with a cap of 30 days. Higher scores indicate more unhealthy days in the past 30 days. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| TASK III Group The Telephone Assessment and Skill-Building Kit (TASK III) group
Telephone Assessment and Skill-Building Kit (TASK III) Group: The TASK III group will receive a TASK III Resource Guide that we developed and 8 weekly calls from a nurse. The nurse will call again a month later. The TASK III nurse will help you assess your needs and concerns, build your skills as a caregiver, and refer you to community resources. | 36 |
| ISR Group The Information, Support, and Referral (ISR) group
Information Support and Referral (ISR) Group: The ISR group will receive an American Heart Association brochure and 8 weekly calls from a nurse. The nurse will call again a month later. The ISR nurse will provide information, support, and referral to community resources. | 38 |
| Total | 74 |
Baseline characteristics
| Characteristic | Total | TASK III Group | ISR Group |
|---|---|---|---|
| Age, Continuous | 57 years STANDARD_DEVIATION 15 | 59 years STANDARD_DEVIATION 13 | 56 years STANDARD_DEVIATION 17 |
| Bakas Caregiving Outcomes Scale (BCOS) | 52.74 units on a scale STANDARD_DEVIATION 11.45 | 51.72 units on a scale STANDARD_DEVIATION 9.71 | 53.71 units on a scale STANDARD_DEVIATION 12.95 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 2 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 72 Participants | 34 Participants | 38 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Patient Health Questionnaire Depression Scale (PHQ-9) | 5.15 units on a scale STANDARD_DEVIATION 5.01 | 5.36 units on a scale STANDARD_DEVIATION 6.02 | 4.95 units on a scale STANDARD_DEVIATION 3.88 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 19 Participants | 10 Participants | 9 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) White | 52 Participants | 25 Participants | 27 Participants |
| Sex: Female, Male Female | 59 Participants | 30 Participants | 29 Participants |
| Sex: Female, Male Male | 15 Participants | 6 Participants | 9 Participants |
| Unhealthy Days | 9.51 Days STANDARD_DEVIATION 9.78 | 9.03 Days STANDARD_DEVIATION 10.57 | 9.97 Days STANDARD_DEVIATION 9.08 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 36 | 0 / 38 |
| other Total, other adverse events | 0 / 36 | 0 / 38 |
| serious Total, serious adverse events | 0 / 36 | 0 / 38 |
Outcome results
Primary
Caregiver Satisfaction Ratings for Both TASK III and ISR Programs Measured by the Caregiver Satisfaction Scale (CSS).
Caregiver satisfaction ratings (usability, ease of use, acceptability) for both TASK III and ISR programs are measured using the Caregiver Satisfaction Scale (CSS). The CSS consists of 9 items rated on a response scale ranging from 1 = Strongly Disagree to 5 = Strongly Agree. Items are summed for a total score, then divided by 9 (number of items) with a possible range of 1 to 5. Higher scores indicate greater satisfaction.
Time frame: 12 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| TASK III Group | Caregiver Satisfaction Ratings for Both TASK III and ISR Programs Measured by the Caregiver Satisfaction Scale (CSS). | 4.59 score on a scale | Standard Deviation 0.47 |
| ISR Group | Caregiver Satisfaction Ratings for Both TASK III and ISR Programs Measured by the Caregiver Satisfaction Scale (CSS). | 4.15 score on a scale | Standard Deviation 0.59 |
Secondary
Depressive Symptoms Measured by the Patient Health Questionnaire Depression Scale (PHQ-9).
Caregiver depressive symptoms are measured by the Patient Health Questionnaire Depression Scale (PHQ-9) consisting of 9 items rated on a response scale ranging from 0 = Not at all to 3 = Nearly every day. Items are summed for a total score with a possible range of 0 to 27. Higher scores indicate higher depressive symptoms.
Time frame: Assessed at Baseline, Week 8, and Week 12, change from Baseline to Week 8 Reported.
Population: As in our prior studies, the number of minutes on the TASK III and ISR calls from the nurse were controlled in our analyses showing data trends as change scores. At each follow-up time point, 8 and 12 weeks, we computed mean differences and 95% CI between groups to evaluate trends in outcomes. Reported here are mean (SE) in change scores from Baseline to 8 weeks.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| TASK III Group | Depressive Symptoms Measured by the Patient Health Questionnaire Depression Scale (PHQ-9). | -2.3 units on a scale | Standard Error 0.7 |
| ISR Group | Depressive Symptoms Measured by the Patient Health Questionnaire Depression Scale (PHQ-9). | -0.6 units on a scale | Standard Error 0.7 |
Secondary
Life Changes (i.e., Changes in Social Functioning, Subjective Well-being, and Physical Health as a Result of Providing Care) Measured by the Bakas Caregiving Outcomes Scale (BCOS).
Caregiver life changes (i.e., changes in social functioning, subjective well-being, and physical health as a result of providing care) are measured by the Bakas Caregiving Outcomes Scale (BCOS). The BCOS consists of 15 items rated on a response scale ranging from -3 (changed for the worst) to +3 (Changed for the best). The items are recoded (-3 = 1) (-2 = 2) (-1 = 3) (0 = 4) (1 = 5) (2 = 6) (3 = 7) so that positive numbers can be obtained for analysis. The recoded responses to the 15 items are summed for a total score with a possible range of 15-105. Higher scores indicate more positive life changes as a result of providing care.
Time frame: Assessed at Baseline, Week 8, and Week 12, change from Baseline to Week 8 Reported.
Population: As in our prior studies, the number of minutes on the TASK III and ISR calls from the nurse were controlled in our analyses showing data trends as change scores. At each follow-up time point, 8 and 12 weeks, we computed mean differences and 95% CI between groups to evaluate trends in outcomes. Reported here are mean (SE) in change scores from Baseline to 8 weeks.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| TASK III Group | Life Changes (i.e., Changes in Social Functioning, Subjective Well-being, and Physical Health as a Result of Providing Care) Measured by the Bakas Caregiving Outcomes Scale (BCOS). | 11.2 units on a scale | Standard Error 2.6 |
| ISR Group | Life Changes (i.e., Changes in Social Functioning, Subjective Well-being, and Physical Health as a Result of Providing Care) Measured by the Bakas Caregiving Outcomes Scale (BCOS). | 3.1 units on a scale | Standard Error 2.4 |
Secondary
Unhealthy Days Measured by the Number of Unhealthy Days in the Past 30 Days.
Caregiver unhealthy days are measured using the Unhealthy Days (UD) measure consisting of two items: How many days during the past 30 days was your physical health not good?; How many days during the past 30 days was your mental health not good? These items range from 0 = no unhealthy days to 30 = 30 unhealthy days. The two items are summed for a total score, with a cap of 30 days. Higher scores indicate more unhealthy days in the past 30 days.
Time frame: Assessed at Baseline, Week 8, and Week 12, change from Baseline to Week 8 Reported.
Population: At each follow-up time point, 8 and 12 weeks, we computed mean differences and 95% CI between groups to evaluate trends in outcomes. Reported here are mean (SE) in change scores from Baseline to 8 weeks.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| TASK III Group | Unhealthy Days Measured by the Number of Unhealthy Days in the Past 30 Days. | 1.93 Days | Standard Error 1.7 |
| ISR Group | Unhealthy Days Measured by the Number of Unhealthy Days in the Past 30 Days. | -1.15 Days | Standard Error 1.72 |