Study of BMT-CARE Finds Coping, Self-Efficacy to Improve QOL, Mood in Caregivers of HSCT Recipients

A study published in Cancer found that coping and self-efficacy are necessary components of a brief psychosocial intervention that improves quality of life (QOL) and mood for caregivers of hematopoietic stem cell transplantation (HSCT) recipients during their acute recovery period.

These results have important implications, given that caregivers of patients undergoing HSCT may endure substantial declines in QOL and are at ongoing risk for depression and anxiety during and after the transplant.

“As previously reported, [brief multimodal psychosocial intervention; BMT-CARE] is a feasible and acceptable approach to managing stress and burden throughout the transplant process and thereby improving QOL and reducing depression and anxiety symptoms,” the authors wrote. “This study provides evidence suggesting that the improvements in QOL and mood experienced by caregivers assigned to BMT-CARE are, in part, explained by an acquisition of effective coping skills and confidence in their ability to provide care for their loved one.”

From December 2017 to April 2019, researchers enrolled 100 caregivers of HSCT recipients into a randomized clinical trial of BMT-CARE versus usual care. Caregivers completed self-report measures of QOL, depression and anxiety symptoms, coping skills, and self-efficacy at enrollment (before HSCT) and 60 days after HSCT was performed.

Ultimately, investigators found that improvements in 60-day QOL in participants assigned to BMT-CARE were mediated, in part, by improved coping and self-efficacy (indirect effect, 6.93; SE, 1.85; 95% CI, 3.71-11.05). Comparably, reductions in 60-day depression and anxiety symptoms were partially mediated by ameliorated coping and self-efficacy (indirect effect for depression, -1.19; SE, 0.42; 95% CI, -2.23 to -0.53; indirect effect for anxiety, -1.46; SE, 0.55; 95% CI, -2.52 to -0.43).

Overall, combined improvements in coping and self-efficacy accounted for 67%, 80%, and 39% of the total intervention effects on QOL, depression, and anxiety symptoms, respectively.

“The current finding that reductions in anxiety and depression symptoms and improvements in QOL were partially mediated by enhanced coping skills for caregivers who received BMT-CARE suggests that the incorporation of skills to boost adaptive coping for caregivers in the acute transplant period is warranted,” the authors wrote.

It is important to note that the generalizability of the current study findings is limited, as this was a single-site trial in a tertiary academic medical setting with a homogenous sample of caregivers. Additionally, due to the sample size, the researchers were not able to control for additional factors that could influence caregiver-reported outcomes in this sort of exploratory analyses.

Given these limitations, future research should replicate these findings using a larger sample size and adjust for additional empirically and theoretically supported factors. Further, future work might also explore even briefer, self-administered interventions to further maximize the scalability and accessibility of this sort of care.

In addition, the investigators indicated they intend to incorporate longer term follow-up in a future multisite study to assess sustained intervention and mediation effects moving forward.

“The current findings provide important insights into what skills caregivers may benefit from most to buffer negative effects on QOL and depression and anxiety symptoms throughout the transplant process,” the authors noted. “Moreover, these findings may be informative for caregiver-directed interventions in other cancer populations.”

Reference:

Jacobs JM, Nelson AM, Traeger L, et al. Enhanced Coping and Self-Efficacy in Caregivers of Stem Cell Transplant Recipients: Identifying Mechanisms of a Multimodal Psychosocial Intervention. Cancer. doi: 10.1002/cncr.33191