Improving Cancer Family Caregivers' Knowledge and Communication About Care Options

Study Overview
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Brief Summary
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The purpose of this two-year mixed methods study is to develop and test an intervention to improve cancer family caregivers' knowledge of care options (curative, palliative, and hospice care) and goals of care communication as part of a self-management (SM) training program. The two specific aims of this project are to: Develop a psycho-educational intervention called Managing Cancer Care: A Caregiver's Guide (MCC-CG), for family caregivers of patients with breast cancer to increase knowledge of care options, goals of care communication, and other SM skills. Evaluate the feasibility and preliminary efficacy of the MCC-CG in a pilot randomized controlled trial compared with an attention-control condition (symptom management education) on knowledge of care options, goals of care communication, and other key SM skills (engagement in SM, management of transitions and uncertainty, increasing self-efficacy, appropriate use of health care resources).

Detailed Description
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The investigators will address and accomplish aim 1 by taking the following steps: Conduct development focus groups with family caregivers of women with breast cancer. Develop the MCC-CG intervention prototype. Conduct feedback focus groups with family caregivers to evaluate the prototype. Revise the MCC-CG. To address and accomplish aim 2, the investigators will do the following: Conduct a pilot RCT to evaluate the feasibility of recruiting and retaining a sample of family caregivers. Assess the initial efficacy of the MCC-CG to improve knowledge of care options, goals of care communication, and other SM skills. Estimate power and determine the best measures for a large RCT testing the MCC-PT and MCC-CG together.

Official Title
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Improving Cancer Family Caregivers' Knowledge and Communication About Care Options

Conditions
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Family Caregivers

Intervention / Treatment
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* Other: Managing Cancer Care: A Caregiver's Guide
* Other: Symptom Management Toolkit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: A family member of an individual with any stage of breast cancer receiving curative, palliative, or hospice care Aged 18+ English speaking Live in Connecticut The patient for whom the participant is a caregiver has a six-month prognosis

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 110 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Family caregivers of breast cancer patients who consent to participate in the study have a 50/50 chance of being randomized to the intervention group and will receive the booklet, Managing Cancer Care: A Caregiver's Guide (MCC-CG) (N=18) | Other: Managing Cancer Care: A Caregiver's Guide<br>* MCC-CG is a set of 7 printed modules including information about caregiver-nominated SM topics, conversation starters to facilitate communication with patients and providers, and links to caregiver resources. The modules are as follows: Becoming a Cancer Caregiver [role, changes, challenges, adjusting, self-care] Basics of Cancer Caregiving [physical, functional, emotional, social, & spiritual support; treatment timeline worksheet] Caregiver's Role in Managing Patient Care [who/what is involved; health care professionals worksheet] Managing Cancer Symptoms and Side Effects [common symptoms/side effects; maintaining health; nutrition & exercise; medication management worksheet] Care Options: [information on curative, palliative and hospice care] Talking About Goals of Care [information on goals of care conversations] Managing Transitions [defining transitions, transition examples, helping yourself and patient to manage transitions; transitions worksheet]<br>* Other names: MCC-CG;|
| Active Comparator: Control<br>Family caregivers of breast cancer patients who consent to participate in the study have a 50/50 chance of being randomized to the control group and will receive the Symptom Management Toolkit (N=17) | Other: Symptom Management Toolkit<br>* Along with an overview of symptom management, the Toolkit provides concise information on commonly experienced symptoms, including fatigue, alopecia, cognitive dysfunction, nausea and vomiting, and sleep problems, among others. Each chapter uses a question-and-answer format to cover the topics of who is most likely to experience the symptom, when and why the symptom may occur, how the symptom can be managed, and when to call a provider. Drs. Schulman-Green and McCorkle have previously tested the Symptom Toolkit in an attention-control group.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Knowledge of Care Options (KOCO) | 11-item questionnaire in true/false format to assess knowledge of curative, palliative, and hospice care. | 3 months | 
| Medical Communication Competence Scale (MCCS) | Adjusted to reflect views of the family caregiver, the MCCS will assess participants' communication skills, including information seeking, providing, and verifying, and socio-emotional communication will be measured using the MCCS. Each item on the MCCS is presented with a Likert scale ranging from 7 (strongly agree) to 1 (strongly disagree). | 3 months | 
| Engagement in Cancer Self-Management Activities Scale (ECSMAS) | The 33-item ECSMAS was developed to measure cancer patients' self-reported self-management. The ECSMAS is organized around three conceptual domains derived from a metasynthesis of process of self-management in chronic illness: focus on illness needs, activating resources, and living with chronic illness. Items are adjusted to reflect views of the family caregiver, and an additional item has been added to the ECSMAS to assess caregivers' ability to manage transitions as a self-management skill (34 items total). | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Goals of Care Conversation | This form documents frequency, perceived quality, and content of goals of care conversations with patients and providers, as well as capturing any transitions experienced. | 3 months | 
| Caregiver Burden Scale (CBS) | This 22-item scale was developed to assess the experience of burden among caregivers, specifically addressing the dimensions of personal strain and role strain. Each item is presented with five response options ranging from 0-4 indicating never, rarely, sometimes, frequently, and nearly always sequentially. | 3 months | 
| Mishel Uncertainty in Illness Scale (MUIS) | Uncertainty will be measured using the 32-item MUIS, which was developed to measure the uncertainty adults perceive regarding symptoms, diagnosis, relationships, and planning for the future. Each item on the MUIS represents uncertainty in terms of a 5-point Likert-type format ranging from 1 (strongly disagree) to 5 (strongly agree). All items adjusted to reflect views of the caregiver. | 3 months | 
| Caregiver Competence Scale | Self-efficacy will be measured using a 4-point Likert scale, with four questions total. | 3 months | 
| Personal Gain Scale | Self-efficacy will be measured using a 4-point Likert scale, with four questions total. | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Caregiver, Self-management, Care options, Goals of care, Breast cancer, Palliative care