Caregiver Burnout
Conditions
Keywords
coping, resilience, quality of life
Brief summary
This research is being done to learn whether services to the caregiver to provide emotional, instrumental and social support can improve quality of life and other outcomes. The Caregiver-Support program provides services that are not usually available to caregivers of persons with heart failure and other chronic conditions.
Detailed description
Family caregivers who care for older adults living with multiple chronic conditions, including heart failure (HF), provide substantial cost savings to the US healthcare system. While caregiving can be meaningful and rewarding, extensive research also demonstrates high rates of chronic disease, fatigue and physiologic measures such as stress hormones among caregivers. Family caregivers are often left juggling caregivers' loved one's healthcare as well as caregivers' own. Unmet needs have been identified including increased stress, financial strain and social isolation, but interventions to address these needs in HF caregivers have had mixed results. Due to the limited impact of many caregiver interventions, experts have called for a greater understanding of the dynamic and contextual factors of family caregiving including resources, needs and social support with an increased focus on individualization of interventions for high-risk caregivers to improve outcomes.Following a mixed methods study to better understand these contextual factors and to address this gap between the evidence and uptake of proven strategies by caregivers, the study team has developed a resilience-promoting intervention to improve quality of life for family caregivers of individuals with multiple chronic conditions, including HF, Caregiver-Support. Caregiver-Support will help caregivers articulate statements of purpose in life, set goals to address fatigue and caregiver burden, provide instrumental support through a benefits check up and promote identification and increased connection with the caregiver's social network. The first phase of the study will be an open label pilot (N=5) followed by a single-masked, two-group, randomized trial (N=40) to test the feasibility and gauge an initial effect size of the intervention. Participants will be visited by study staff in participants' homes for all data collection and intervention visits. Participants will be randomized to receive either the immediate intervention group or the waitlist control group. In the waitlist control group, participants will receive usual care for the first 16 weeks (which is limited to printed materials provided in the clinic) and then begin the intervention. The intervention will consist of 5 in-home sessions with a nurse interventionist. Each participant will receive each intervention component but interventionists will systematically tailor content to the participants' goals based on protocols. All participants will be reassessed at 16 weeks (in person) and 32 weeks (by phone) by a research assistant (RA) masked to treatment condition. The primary outcome will be improvement in quality of life between baseline and 16 weeks. Other endpoints include group differences in fatigue, caregiver burden, self-reported and physiological measures of resilience up through 32 weeks after the intervention. The investigators will also examine the acceptability of the intervention using intervention compliance and participant satisfaction data.
Interventions
BEHAVIORALCaregiver-Support
intervention incorporating 5 individualized, nurse-led, home-based sessions, with telephone check-ins and text reminders, according to participant preference. Caregiver-Support will help caregivers articulate statements of purpose in life, set goals to address fatigue and caregiver burden, provide instrumental support through a benefits check up and promote identification and increased connection with the caregiver's social network.
Sponsors
National Institute of Nursing Research (NINR)
Johns Hopkins University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Masking description
The research assistant collecting data will be blinded to group assignment for each participant.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Primary family caregivers, will be identified by patients and providers in the Bridge Clinic * must live with the patient or visit at least 3 times per week for the purposes of care provision * provide support for at least one Instrumental Activity of Daily Living, * Be able to speak English.
Exclusion criteria
* Caregivers with terminal diagnosis will be excluded as goal-setting at end of life may be different than without a terminal diagnosis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quality of Life as Assessed by the Short Form Health Survey | 16 weeks and 32 weeks | The Short Form Health Survey (36 items) measures self-rated quality of life using 8 sub-scales. Items are scored on a 0-100 range, with total scores averaged for each subscale. The eight domains are also averaged to create an overall score from 0-100. Higher scores indicate a more favorable health state. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Fatigue as Assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) | 16 weeks and 32 weeks | The PROMIS 7-item fatigue measure has a score range from 0-35 with higher scores indicating higher levels of fatigue. We use T-scores for analysis (where standard scores with a mean of 50 and standard deviation of 10 in the U.S. general population). |
| Caregiver Burden as Assessed by the Oberst Caregiving Burden Scale | 16 weeks and 32 weeks | The investigators will use the task difficulty and time caring subscales of the Oberst Caregiving Burden Scale, which include 15 likert scale items. Scores range from 15-75. Higher scores indicate greater task difficulty and more time spent on each task, higher burden. |
| Caregiver Burden as Assessed by the Zarit Caregiver Burden Interview (ZBI) | 16 weeks and 32 weeks | The ZBI is a 12 item measure with higher scores representing higher feelings of burden; the range of summed scores is 0-48. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in Interleukin 10 (pg/ml) | Baseline, 16 weeks and 32 weeks | Participants will wear a non-occlusive sweatpatch to collect interleukin 10. Higher levels of interleukin 10 suggest increased activation of the anti-inflammatory response and increased resilience to stress. |
| Change in Resilience to Stress as Assessed by Heart Rate Variability | Baseline, 16 weeks and 32 weeks | Participants will touch a finger pad for 2-5 minutes to obtain heart rate variability. Heart rate variability is assessed through multiple calculations including: percentage of pairs of adjacent N-N intervals differing by more than 50 milliseconds (pNN50), high-frequency power (HF power), and low frequency to high frequency (LF/HF) ratio. Higher pNN50, HF power and LF/HF ratio levels suggest increased resilience to stress. |
| Change in Interleukin 6 (ng/mL) | Baseline, 16 weeks and 32 weeks | Participants will wear a non-occlusive sweatpatch to collect interleukin 6. Higher levels of interleukin 6 suggest increased activation of inflammatory response and decreased resilience to stress. |
Countries
United States
Participant flow
Pre-assignment details
Of the 38 enrolled participants, 3 withdrew and 8 were lost to follow up prior to baseline data collection and randomization.
Participants by arm
| Arm | Count |
|---|---|
| Open Label Pilot This group was the first consented participants and was not randomized, but instead all participants received the intervention. Information from this group was used to test study procedures and make final minor changes to the intervention protocol. | 3 |
| Immediate Intervention The immediate intervention group received the intervention during weeks 0-16. There was an assessment at week 32 to examine maintenance on primary and secondary outcomes.
Caregiver-Support: intervention incorporating 5 individualized, nurse-led, home-based sessions, with telephone check-ins and text reminders, according to participant preference. Caregiver-Support will help caregivers articulate statements of purpose in life, set goals to address fatigue and caregiver burden, provide instrumental support through a benefits check up and promote identification and increased connection with the caregiver's social network. | 12 |
| Waitlist Control The waitlist control group was provided written materials with community resources for caregivers during the first 16 weeks, then the intervention began. | 12 |
| Total | 27 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Open Label Pilot | Lost to Follow-up | 1 | 0 | 0 |
| Pilot Trial | Care recipient of enrolled caregiver died | 0 | 1 | 0 |
| Pilot Trial | Lost to Follow-up | 0 | 1 | 1 |
Baseline characteristics
| Characteristic | Total | Open Label Pilot | Immediate Intervention | Waitlist Control |
|---|---|---|---|---|
| Age, Continuous | 59 years STANDARD_DEVIATION 16.9 | 60 years STANDARD_DEVIATION 12 | 55.8 years STANDARD_DEVIATION 19.6 | 62.1 years STANDARD_DEVIATION 13.9 |
| Caregiver Burden | 14.75 units on a scale STANDARD_DEVIATION 12 | 14.8 units on a scale STANDARD_DEVIATION 10 | 15.1 units on a scale STANDARD_DEVIATION 11.2 | 14.4 units on a scale STANDARD_DEVIATION 15.3 |
| Quality of Life (mental) | 70.5 units on a scale STANDARD_DEVIATION 19.5 | 65.2 units on a scale STANDARD_DEVIATION 17.1 | 63.4 units on a scale STANDARD_DEVIATION 18.8 | 77.6 units on a scale STANDARD_DEVIATION 20.1 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 10 Participants | 2 Participants | 7 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 17 Participants | 1 Participants | 5 Participants | 11 Participants |
| Region of Enrollment United States | 27 Participants | 3 Participants | 12 Participants | 12 Participants |
| Sex: Female, Male Female | 25 Participants | 3 Participants | 11 Participants | 11 Participants |
| Sex: Female, Male Male | 2 Participants | 0 Participants | 1 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 12 | 0 / 12 | 0 / 3 |
| other Total, other adverse events | 0 / 12 | 0 / 12 | 0 / 3 |
| serious Total, serious adverse events | 0 / 12 | 0 / 12 | 0 / 3 |
Outcome results
Primary
Quality of Life as Assessed by the Short Form Health Survey
The Short Form Health Survey (36 items) measures self-rated quality of life using 8 sub-scales. Items are scored on a 0-100 range, with total scores averaged for each subscale. The eight domains are also averaged to create an overall score from 0-100. Higher scores indicate a more favorable health state.
Time frame: 16 weeks and 32 weeks
Population: 1 open label pilot participant did not start the intervention after completing the baseline surveys and did not complete subsequent timepoints for the surveys. The open label pilot participants did not complete the 32 week data collection.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Open Label Pilot | Quality of Life as Assessed by the Short Form Health Survey | 16 weeks | 72.3 units on a scale | Standard Deviation 25.9 |
| Immediate Intervention | Quality of Life as Assessed by the Short Form Health Survey | 16 weeks | 74.1 units on a scale | Standard Deviation 20.6 |
| Immediate Intervention | Quality of Life as Assessed by the Short Form Health Survey | 32 weeks | 76.1 units on a scale | Standard Deviation 21.2 |
| Waitlist Control | Quality of Life as Assessed by the Short Form Health Survey | 16 weeks | 70.4 units on a scale | Standard Deviation 20.6 |
| Waitlist Control | Quality of Life as Assessed by the Short Form Health Survey | 32 weeks | 74.0 units on a scale | Standard Deviation 21.2 |
Secondary
Caregiver Burden as Assessed by the Oberst Caregiving Burden Scale
The investigators will use the task difficulty and time caring subscales of the Oberst Caregiving Burden Scale, which include 15 likert scale items. Scores range from 15-75. Higher scores indicate greater task difficulty and more time spent on each task, higher burden.
Time frame: 16 weeks and 32 weeks
Population: 1 open label pilot participant did not start the intervention after completing the baseline surveys and did not complete subsequent timepoints for the surveys. The open label pilot participants did not complete the 32 week data collection.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Open Label Pilot | Caregiver Burden as Assessed by the Oberst Caregiving Burden Scale | 16 weeks | 44 units on a scale | Standard Deviation 4.8 |
| Immediate Intervention | Caregiver Burden as Assessed by the Oberst Caregiving Burden Scale | 16 weeks | 46 units on a scale | Standard Deviation 3.4 |
| Immediate Intervention | Caregiver Burden as Assessed by the Oberst Caregiving Burden Scale | 32 weeks | 38.5 units on a scale | Standard Deviation 3.2 |
| Waitlist Control | Caregiver Burden as Assessed by the Oberst Caregiving Burden Scale | 16 weeks | 39.3 units on a scale | Standard Deviation 4.5 |
| Waitlist Control | Caregiver Burden as Assessed by the Oberst Caregiving Burden Scale | 32 weeks | 37.5 units on a scale | Standard Deviation 4.6 |
Secondary
Caregiver Burden as Assessed by the Zarit Caregiver Burden Interview (ZBI)
The ZBI is a 12 item measure with higher scores representing higher feelings of burden; the range of summed scores is 0-48.
Time frame: 16 weeks and 32 weeks
Population: 1 open label pilot participant did not start the intervention after completing the baseline surveys and did not complete subsequent timepoints for the surveys. The open label pilot participants did not complete the 32 week data collection.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Open Label Pilot | Caregiver Burden as Assessed by the Zarit Caregiver Burden Interview (ZBI) | 16 weeks | 13.9 units on a scale | Standard Deviation 10.2 |
| Immediate Intervention | Caregiver Burden as Assessed by the Zarit Caregiver Burden Interview (ZBI) | 32 weeks | 10.2 units on a scale | Standard Deviation 9 |
| Immediate Intervention | Caregiver Burden as Assessed by the Zarit Caregiver Burden Interview (ZBI) | 16 weeks | 11.3 units on a scale | Standard Deviation 10.6 |
| Waitlist Control | Caregiver Burden as Assessed by the Zarit Caregiver Burden Interview (ZBI) | 16 weeks | 14.8 units on a scale | Standard Deviation 10.6 |
| Waitlist Control | Caregiver Burden as Assessed by the Zarit Caregiver Burden Interview (ZBI) | 32 weeks | 9.9 units on a scale | Standard Deviation 9 |
Secondary
Fatigue as Assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS)
The PROMIS 7-item fatigue measure has a score range from 0-35 with higher scores indicating higher levels of fatigue. We use T-scores for analysis (where standard scores with a mean of 50 and standard deviation of 10 in the U.S. general population).
Time frame: 16 weeks and 32 weeks
Population: 1 open label pilot participant did not start the intervention after completing the baseline surveys and did not complete subsequent timepoints for the surveys. The open label pilot participants did not complete the 32 week data collection.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Open Label Pilot | Fatigue as Assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) | 16 weeks | 50.3 units on a scale | Standard Deviation 8.1 |
| Immediate Intervention | Fatigue as Assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) | 16 weeks | 54.3 units on a scale | Standard Deviation 7.7 |
| Immediate Intervention | Fatigue as Assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) | 32 weeks | 48.2 units on a scale | Standard Deviation 9 |
| Waitlist Control | Fatigue as Assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) | 16 weeks | 49.1 units on a scale | Standard Deviation 10.7 |
| Waitlist Control | Fatigue as Assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS) | 32 weeks | 53.6 units on a scale | Standard Deviation 14.9 |
Other Pre-specified
Change in Interleukin 10 (pg/ml)
Participants will wear a non-occlusive sweatpatch to collect interleukin 10. Higher levels of interleukin 10 suggest increased activation of the anti-inflammatory response and increased resilience to stress.
Time frame: Baseline, 16 weeks and 32 weeks
Other Pre-specified
Change in Interleukin 6 (ng/mL)
Participants will wear a non-occlusive sweatpatch to collect interleukin 6. Higher levels of interleukin 6 suggest increased activation of inflammatory response and decreased resilience to stress.
Time frame: Baseline, 16 weeks and 32 weeks
Other Pre-specified
Change in Resilience to Stress as Assessed by Heart Rate Variability
Participants will touch a finger pad for 2-5 minutes to obtain heart rate variability. Heart rate variability is assessed through multiple calculations including: percentage of pairs of adjacent N-N intervals differing by more than 50 milliseconds (pNN50), high-frequency power (HF power), and low frequency to high frequency (LF/HF) ratio. Higher pNN50, HF power and LF/HF ratio levels suggest increased resilience to stress.
Time frame: Baseline, 16 weeks and 32 weeks