Stroke is the leading cause of long-term disability;families are often thrust into providing care for stroke survivors without any training. Stroke family caregivers are of increasing importance because the prevalence of stroke is likely to increase as the population ages. However, there are very few evidence-based, easy-to- deliver follow-up programs after hospitalization to train caregivers in providing care and none that comprehensively address both caregiver and survivor needs through skill-building strategies. Studies have shown that caregiving without training can be detrimental to caregiver's physical and mental health, which can lead to institutionalization of the survivor and higher societal costs. The purpose of this study is to evaluate the efficacy of the revised Telephone Assessment and Skill-building Kit (TASK II), a nurse-led comprehensive intervention that enables caregivers to build skills based on assessment of their own needs. Family caregivers of stroke survivors (N=220) will be randomized to the TASK II intervention or to an Information, Support, and Referral (ISR) group to determine the relative efficacy of the TASK II intervention for reducing task difficulty, increasing optimism, and reducing threat appraisal for providing care. Primary outcomes are caregiver depressive symptoms, caregiving-related negative life changes, and unhealthy days. In an exploratory aim preliminary data will be collected for an economic evaluation of the TASK II intervention. Both the TASK II intervention and ISR procedures involve 8 telephone sessions delivered over 8 weeks, with a booster session at 12 weeks. Data collections will occur at baseline (within 8 weeks of home discharge);at 8 weeks (short-term intervention effect), 12 weeks (after booster), and at 24 weeks and 1 year after baseline (long-term sustainability of intervention effect). Linear mixed models will be applied to the repeated-measures data to test efficacy for Primary Aims 1 &2. Latent Growth Models using a Structural Equation Model approach will be applied to examine mechanism of intervention effect (Exploratory Aim 1.). An incremental cost-effectiveness ratio (ICER) will be employed to address the comparative costs and outcomes for the TASK II intervention and ISR group (Exploratory Aim 2).

Public Health Relevance

Caring for a family member during the first year after a stroke can be very difficult. The TASK II intervention is a unique, comprehensive caregiver intervention program that enables caregivers to develop the necessary skills to manage care for the survivor, while also taking care of themselves as a caregiver. The long-term goal of this study is to offer training and support for family caregivers through an efficacious, cost-effective program.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR010388-04
Application #
8431775
Study Section
Special Emphasis Panel (ZRG1-HDM-G (03))
Program Officer
Matocha, Martha F
Project Start
2010-05-21
Project End
2015-02-28
Budget Start
2013-03-01
Budget End
2014-02-28
Support Year
4
Fiscal Year
2013
Total Cost
$361,330
Indirect Cost
$126,700
Name
Indiana University-Purdue University at Indianapolis
Department
Public Health & Prev Medicine
Type
Schools of Nursing
DUNS #
603007902
City
Indianapolis
State
IN
Country
United States
Zip Code
46202
McLennon, Susan M; Bakas, Tamilyn; Jessup, Nenette M et al. (2014) Task difficulty and life changes among stroke family caregivers: relationship to depressive symptoms. Arch Phys Med Rehabil 95:2484-90
Gonzalez, Carmanny; Bakas, Tamilyn (2013) Factors associated with stroke survivor behaviors as identified by family caregivers. Rehabil Nurs 38:202-11
Bakas, Tamilyn; Li, Yong; Habermann, Barbara et al. (2011) Developing a cost template for a nurse-led stroke caregiver intervention program. Clin Nurse Spec 25:41-6