There are an estimated 7 million family caregivers who live at least one hour from the care recipient and are described as distance caregivers (DCGs)1,2,3. DCGs are a growing demographic; a majority are significantly involved in making care decisions as well as managing daily aspects of their family member's care (transportation, finances)3-7. Their anxiety, distress, depression, and poor health status are comparable to, and at times worse than, their local counterparts and they incur financial costs due to travel or lost work time that far exceed those of local caregivers3. A particularly vulnerable sub-population of DCGs are those of patients with advanced cancer-many of whom are near the end of life. To date, no one has tested an intervention aimed at the unique needs of this vulnerable and growing group of caregivers. The need to improve outcomes for DCGs is well recognized and there have been national calls to examine interventions for DCGs1,19-21. We will be the first to test interventions tailored to the unique needs of DCGs and delivered using a videoconference format. The goal of this randomized trial is to test the effectiveness of two arms of an intervention that use videoconference technology for DCGs of patients with advanced cancer. Key components of the full intervention have been tested46,52 and shown effective in reducing untoward caregiver psychological outcomes; they have not been fully tested with DCGs using videoconference technology. The first arm (Closer), will provide a minimum of four videoconference meetings (over a 4-month period) where DCGs participate in patient-oncologist office visits. Also, each DCG will receive a minimum of four personalized coaching sessions (via videoconference) from a registered nurse trained to deliver the key components of the intervention. The second arm (Video-C Only) will consist solely of videoconferences that include the DCG during patient-oncologist office visits-a minimum of four meetings over a 4 month period. The control group will have access to a website (Web-Only) with links to publically available information on cancer, caregiving, and distance caregiving. We project enrolling 613 DCG subjects and patients over a 3 year enrollment period. The study aims are to: 1) Compare the direct effects of Closer, Video-C Only, and Web- Only on DCG outcomes (anxiety, distress, depression, health status) over time, controlling for DCG demographic variables, 2) Examine the indirect effects of Closer, Video-C Only, and Web-Only on DCG outcomes (anxiety, distress, depression, health status) over time, controlling for DCG demographic variables, and 3) Examine the relationships between DCG distress, anxiety, depression and health status and patient distress, anxiety and depression over time. Impact: This will be the first study to test interventions tailored to the unique needs of DCGs using a videoconference format. If our aims are met, use of the Closer intervention has the potential to reach all caregivers who experience barriers to active participation in their family member's care-regardless of distance.
The proposed research study explores a tested intervention delivered via videoconference that provides information and emotional support to improve distance caregivers' anxiety, distress, depression and health status. The study is highly relevant to public health as it affects the health of a growing segment of our population-those who are significantly involved in making care decisions and managing daily aspects of their family member's care, but who live at least an hour from the care recipient.
