To address unmet caregiver needs through skill-building interventions as opposed to psycho-educational support interventions
Patient Reported Outcomes
- (Bakas et al., 2009)
The wide variety of unmet stroke caregiver needs (e.g. obtaining information, managing emotions and behaviours, providing physical and instrument care, dealing with personal responses) that contribute to negative caregiver outcomes (e.g. difficulty with tasks, high threat appraisal, depressive symptoms, negative life changes, poor health) underscore the need for multicomponent caregiver interventions in this population.
- TASK is an 8-week program derived from Lazarus’ transactional theory of stress that addresses 6 outcomes: optimism, task difficulty, threat appraisal, depressive symptoms, life changes, general health perceptions. The program involves: a TASK notebook containing 38 written tip sheets, a stress management workbook, a brochure on family caregiving from the American Stroke Association, and eight weekly calls by a nurse who facilitates caregivers’ weekly assessment of skill needs and provides individualized interventions that address priority skill needs identified by the caregiver.
- The tip sheets were developed for each of the 32 items in the Caregiver Needs and Concerns Checklist (CNCC) addressing the five areas of skill-building needs: A) finding information about stroke; B) managing the survivor’s emotions and behaviours; C) providing physical care; D) providing instrumental care; E) dealing with personal responses to providing care.
- Baseline data regarding caregiver and stroke survivor characteristics is collected as follows:
Stroke Specific Quality of Life Scale Proxy (SSQOL-Pr), for measuring quality of life in stroke survivors
Revised Life Orientation Test (LOT-R), for measuring caregiver optimism
Oberst Caregiving Burden Scale Difficulty Subscale (OCBS), for measuring the perceived difficulty associate with 15 different types of caregiving tasks
Appraisal of Caregiving Threat Subscale (ACS), for measuring threat appraisal, that is the degree to which caregivers’ tasks, relationships, interpersonal support, lifestyle, emotional and physical health, and the overall personal impact of caregiving are appraised as threatening
Patient Health Questionnaire Depression Scale (PHQ-9), for measuring caregiver depressive symptoms
Bakas Caregiving Outcomes Scale (BCOS), for measuring caregiver life changes
SF-36 Health Survey General Health Subscale (SF-36GH), for measuring psychometric properties
Mean number of minutes spent with the TASK nurse = 236.8 minutes
(Bakas et al., 2009)A need to improve the TASK intervention caregiver depressive symptoms and positive caregiver life changes indirectly through the proximal outcomes of optimism, threat appraisal, and task difficulty but to influence depressive symptoms and life changes directly.Rather than waiting for caregivers to begin to self-identify their needs, the TASK intervention should be enhanced by actively screening for caregiver life changes earlier in the intervention process to allow more time to focus on the caregiver’s personal responses to providing care.The point at which caregivers should be screened for depressive symptoms, life changes, and healthy behaviours to further individualize skill-building interventions to address more distal stroke caregiver outcomes requires further study. A larger, more adequately powered randomized controlled clinical trial is recommended to test the revised TASK intervention using an intent-to-treat design. Generalizibility of these findings is limited to stroke family caregivers of these study—caregivers from minority groups other than African American are poorly represented.