Background: Caregiver depression and burden are common following a family member's stroke and are major contributors of stroke survivors' functional recovery, resource use, and institutionalization. Previous studies reveal that problem-solving interventions are effective in improving caregiver and Veteran outcomes post-stroke. However, most of these studies were burdensome for caregivers and labor intensive because they involved multiple, face-to-face sessions. To overcome this shortcoming, our long-term goal is to implement caregiver programs that involve low-cost, evidence-based interventions that can be sustained in routine clinical practice. Our immediate objective is to pilot test a problem-solving intervention that uses telephone support plus the Internet (i.e., our team's previously developed and nationally available RESCUE website) to improve the quality of caregiving and the rehabilitation of Veterans. This pilot RCT simulates all aspects of a planned, future merit review proposal. This work builds on our team's extensive experience in caregiver education.
Aim #1 : To explore the impact of a 4-session and 8-session Internet and telephone support intervention on stroke caregiver and Veteran outcomes when compared to an attention-control condition and standard care. We will obtain preliminary data on effect estimates, group differences, and information on variability, correlations, and data ranges. Data will inform a sample size calculation for the largr trial and provide preliminary information on the impact of different doses of the intervention.
Aim #2 : To test the feasibility of the methods and procedures in our proposed project.
This aim will uncover weaknesses in our project. These findings will help us circumvent problems in the future merit project.
Aim #3 : Determine caregivers' perceptions of the interventions and the attention control condition: Acceptability, facilitators/barriers, credibility of the nurse interventionists. We will learn the strengths and weaknesses of the project, thereby helping us make improvements in our future merit project. Methods: We will conduct a randomized controlled trial with three assessment points (baseline and two post- tests) and use mixed methods to determine caregivers' perceptions of the intervention and the attention control condition. We will enroll 48 stroke caregivers whose Veterans receive care in VISN8. Eligible caregivers will complete baseline measures and then will be randomized to four arms: 1) 4-session intervention, 2) 8-session intervention, 3) attention control condition, or 4) standard care. Two trained registered nurses will conduct the combined Internet and telephone intervention and the attention-control condition. The intervention is based on the relational/problem-solving model of stress originally developed by D-Zurilla and Nezu. We will modify the traditional, problem-solving intervention by adding web-based training using interactive modules, factsheets, and tools on our national RESCUE Stroke Caregiver website. (www.rorc.research.va.gov/rescue). For the first post-test, the research assistant (RA) will telephone caregivers to answer questions on instruments with established reliability and validity. A second post-test will be conducted four or five months after the baseline assessment to evaluate longer-term effects. Qualitative interviews will be conducted with 18 caregivers to obtain in-depth perceptions of the credibility of nurses, and value, facilitators, and barriers of he intervention and the attention control condition. Throughout all study phases, we will collaborate with VA partners (Offices of Nursing Service, Office of Geriatrics and Extended Care, My HealtheVet Program). Impact: Findings will lead to a merit award project to test an intervention that potentially will reduce caregiver depression, improve rehabilitation of Veterans post-stroke and reduce healthcare resource use. Another outcome will an updated, state-of-the art, nationally available website that healthcare providers can use for patient education, discharge planning, and rehabilitative home care. Long-term, the project will lead to an evidenced-base intervention that can be transportable for use in caring for Veterans with other disabilities.
The proposed intervention is novel and the first known to evaluate a telephone support intervention combined with a nationally available website (i.e., RESCUE stroke caregiver). The intervention is aligned with recommendations from national associations that post-discharge telephone follow-up with stroke caregivers should include problem solving and support. Findings in this pilot project will inform the development of a merit award project to test the efficacy of he intervention. The proposed intervention has the potential to reduce stroke caregiver depression, improve the rehabilitation of Veterans post-stroke, enable Veterans to remain in their homes, and reduce healthcare costs. Another outcome will be an updated and improved state-of-the art, nationally available website that healthcare providers can use for patient education, discharge planning, and rehabilitative home care. Ultimately, the project will lead to an evidenced-based intervention that can be transportable for use in improving outcomes of caregivers of Veterans with other disabilities.
