Acute Neurological Injury, Emotional Distress
Conditions
Keywords
Neurological Injury, Emotional Distress, Dyadic Intervention
Brief summary
The purpose of the present investigation is to test the efficacy of a brief (6 sessions) dyadic (patient and caregiver together) intervention to prevent chronic emotional distress in at risk dyads admitted to a Neuroscience Intensive Care Unit with an acute brain injury. Through this study, we seek to solve the unmet need of preventing chronic emotional distress in Neuroscience Intensive Care Unit (NICU) dyads through a feasible, acceptable and credible program, and ideally improve the recovery trajectory and dyads' overall quality of life.
Detailed description
The goals of this study are to: 1) demonstrate the efficacy of Recovering Together for improving self-reported emotional distress (primary outcome), and post traumatic stress, mindfulness, coping, social support and other relevant outcomes (secondary outcomes); and 2) assess mechanisms (mediators and moderators) of improvement after intervention. We will enroll and randomly assign 194 at risk dyads (97 per study group) to receive either the active intervention or educational control. The trial is single blinded (assessors, patients and staff). The trial will take place at the Massachusetts General Hospital NICU using our established methodology successfully implemented during the R21 pilot study. Study clinicians will deliver 6, 30 minute sessions of active intervention or educational control (2 at bedside and 4 via live video after discharge) to each patient-caregiver dyad. All participants will complete measures at baseline, after completion of program (6 weeks) and 3 months later. They will also complete measures of emotional distress weekly, as well as measures assessing home practice.
Interventions
BEHAVIORALRecovering Together
In the skills-based intervention group, sessions focus on developing skills to cope and manage ANI related stressors. The intervention will be tailored consistent with AHA recommendations for ANI skills-based interventions and will include 2 general and 4 specific modules. It is anticipated that the intervention will have 6 sessions with 2 general sessions delivered, in person if possible, within the NICU, or through live video using Zoom if patients leave the hospital before sessions occur, and 4 tailored specific sessions (chosen from by the dyads from 6 available modules) to be delivered via live video using Zoom.
Sponsors
Massachusetts General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 or older * English fluency and literacy * Patient with an informal caregiver available and willing to participate * Hospitalized with any ANI within 6 weeks (patient) OR informal caregiver of a patient currently admitted with any ANI * Patient and/or caregiver exhibit emotional distress on screening (using HADS D and/or HADS A scores \> 7)
Exclusion criteria
* Permanent cognitive impairment (including severe hearing impairment) or aphasia that makes participation impossible * Short form of Mini-Mental State Exam (SMMSE) score \<4 (If SMMSE \<4, nursing team decides whether or not the patient can meaningfully participate) * Glasgow Coma Scale (GCS) score \<10 * Terminal diagnosis * Lack of access to internet and/or a device with a camera * Current untreated or unstable severe mental health conditions like bipolar disorder, schizophrenia, or active substance use
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Emotional Distress | 0 weeks, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 3 months | Hospital Depression and Anxiety Scale total score (HADS); 0-21 for each subscale (anxiety and depression), higher scores indicate greater anxiety or depression |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Post-Traumatic Stress | 0 weeks, 6 weeks, 3 months | Post-Traumatic Stress Disorder Checklist - Specific Event (PCL-S); 17-85, higher scores indicate greater post-traumatic stress |
| Change in Resiliency Factors (Mindfulness - curiosity and de-centering) | 0 weeks, 6 weeks, 3 months | Toronto Mindfulness Scale-Trait (TMS-Trait); 0-52, higher scores indicate greater perceived mindfulness (specifically curiosity and de-centering) |
| Change in Resiliency Factors (Mindfulness) | 0 weeks, 6 weeks, 3 months | Cognitive and Affective Mindfulness Scale (CAMS); 12-48, higher scores indicate greater perceived mindfulness |
| Change in Resiliency Factors (Individual Coping) | 0 weeks, 6 weeks, 3 months | Measure of Current Status Part A (MOCS-A); 0-52; higher scores indicate greater perceived ability to cope |
| Change in Resiliency Factors (Dyadic Coping) | 0 weeks, 6 weeks, 3 months | Dyadic Coping Inventory (DCI); 35-175; higher scores indicate greater perceived coping in the context of a relationship |
| Change in Interpersonal Factors (perceived social support) | 0 weeks, 6 weeks, 3 months | Interpersonal Support Evaluation List-12 (ISEL-12); 0-48, higher scores indicate greater perceived social support |
| Change in Interpersonal Factors (avoidant or anxious communication) | 0 weeks, 6 weeks, 3 months | Experiences in Close Relationships Scale short form (ECR-S); 7-42, higher scores indicate greater avoidant or anxious communication |
| Change in Interpersonal Factors (dyadic strain and positive interpersonal interactions) | 0 weeks, 6 weeks, 3 months | Dyadic Relationship Scale (DRS); Patient version: 10-40, caregiver version: 11-44, dyadic strain subscale: higher scores indicate greater levels of strain, positive dyadic interaction subscale: higher scores indicate greater levels of positive interaction |
Countries
United States
Outcome results
None listed