ONS Connect - November 2008 - (Page 19)

Figure 1. Interventions for Caregiver Strain and Burden Likely to Be Effective • Psychoeducational interventions that provide education to caregivers in an individual or group format • Psychotherapy interventions in which caregivers work with trained professionals to identify strategies to manage distress • Supportive interventions that teach caregivers problem-solving and coping skills • Multicomponent interventions that use combinations of competence, supportive, psychotherapy, respite or adult day care, and miscellaneous interventions Effectiveness Not Established • Discussing psychosocial issues • Identifying available resources and discussing coordination of services • Massage or healing touch • Respite or adult day care • Teaching caregiver self-care, pain management, or symptom management Effectiveness Unlikely • Interventions directed at improving patient competence Note. Based on information from Honea et al., 2008. Cognitive-behavioral Interventions Are recommended for Practice The ONS Caregiver Strain and Burden PEP card, along with ONS’s other PEP cards, is currently being updated with new evidence that has been released since the first card was developed. The full revision will be available in May 2009, but in the meantime, the PEP team has found that one group of interventions has the highest level of evidence and can be recommended for practice: cognitive-behavioral interventions. These interventions focus on changing caregivers’ perceptions of their ability to control a situation, including challenging their negative thoughts that encourage problematic behaviors; using strategies that facilitate development of problem-solving abilities; and focusing on managing time, work, and emotional reactions. were included in this category and are considered likely to be effective. Psychotherapy and cognitive-behavioral approaches facilitate the development of a therapeutic relationship between caregivers and trained professionals. Examples include challenging thoughts or assumptions that encourage difficult behaviors, using strategies that help develop problem-solving abilities, or encouraging caregivers to engage in pleasant activities and positive experiences; this category is considered likely to be effective. Multicomponent interventions employ combinations of psychoeducational, supportive, psychotherapy, and respite interventions. This intervention was identified as likely to be effective. One study investigated massage or heal ing touch approaches that were delivered by certified therapists in the outpatient setting. The ONS PEP team identified this category as effectiveness not established. Respite or adult day care is designed to give caregivers important time away from caregiving demands, such as help with activities of daily living, supervision, or more skilled nursing care. This intervention’s effectiveness is not established. Interventions aimed at improving patient competence use memory clinics for patients with dementia or activity therapy programs to improve patients’ affect and daily competence. According to the ONS PEP team, these interventions are unlikely to be effective. Honea et al. (2008) said that many of the studies were identified as effectiveness not established because they were qualitative, descriptive, cross-sectional, or nonexperimental designs and not randomized clinical trials. The authors said that the interventions without strong evidence can still be useful and recommended. Refer to the full article by Honea et al. for additional information on assessing and managing caregiver strain and burden. The ONS PEP card on caregiver strain and burden is in volume 2 of the ONS PEP cards, which also contains cards on dyspnea, depression, constipation, mucositis, and peripheral neuropathy. To order the pocket cards, visit http:// esource.ons.org/Publications or e-mail customerservice@ons.org. ✱ Honea, N.J., Brintnall, R.A., Given, B., Sherwood, P., Colao, D.B., Somers, S.C., et al. (2008). Putting Evidence Into Practice®: Nursing assessment and interventions to reduce family caregiver strain and burden. Clinical Journal of Oncology Nursing, 12(9), 507–516. Retrieved October 9, 2008, from http://ons.metapress .com/content/j448565361481228/fulltext.pdf Supportive interventions are offered in an individual or group format and are led by a professional or peer. Programs that use the group setting to provide mutual support, share ways to deal with caregiving difficulties, or identify strategies to incorporate these ideas into care November 2008 ONS CONNECT 19 http://esource.ons.org/Publications http://esource.ons.org/Publications http://ons.metapress.com/content/j448565361481228/fulltext.pdf http://ons.metapress.com/content/j448565361481228/fulltext.pdf

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ONS Connect - November 2008 Contents Editor's Note Just In Lean on Me You Tell Us A Year in the Life-- Month Eleven Put Evidence Into Practice to Manage Caregiver Strain and Burden Web Connect Capitol Connection Caregiver Care New Technique Monitors Patients with NSCLC Calendar of Events Working for You Staying on Top

ONS Connect - November 2008

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