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Caregiver Support in the Context of Multiple Chronic Conditions

Primary Purpose

Caregiver Burnout

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Caregiver-Support
Sponsored by
Johns Hopkins University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Caregiver Burnout focused on measuring coping, resilience, quality of life

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Primary family caregivers, will be identified by patients and providers in the Bridge Clinic
  • must live with the patient or visit at least 3 times per week for the purposes of care provision
  • provide support for at least one Instrumental Activity of Daily Living,
  • Be able to speak English.

Exclusion Criteria:

  • Caregivers with terminal diagnosis will be excluded as goal-setting at end of life may be different than without a terminal diagnosis.

Sites / Locations

  • Johns Hopkins School of Nursing

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Other

Experimental

Arm Label

Open Label Group

Waitlist Control

Immediate Intervention

Arm Description

In this arm, 5 participants will be enrolled in the intervention without blinding or randomization. The intervention and study delivery will be improved based on findings from this arm.

The waitlist control group (n=20) will be provided written materials with community resources for caregivers during the first 16 weeks, then the intervention will begin.

The immediate intervention group (n=20) will receive the intervention during weeks 0-16. There will be assessment at week 32 to examine maintenance on primary and secondary outcomes.

Outcomes

Primary Outcome Measures

Change in Quality of Life as assessed by the Short Form Health Survey
The Short Form Health Survey (36 items) measures self-rated quality of life using 8 sub-scales. Items are scored on a 0-100 range, with total scores averaged for each subscale. The eight domains are also averaged to create an overall score from 0-100. Higher scores indicate a more favorable health state.

Secondary Outcome Measures

Change in Fatigue as assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS)
The PROMIS 7-item fatigue measure has a score range from 0-35 with higher scores indicating higher levels of fatigue.
Change in Caregiver Burden as assessed by the Oberst Caregiving Burden Scale
The investigators will use the task difficulty and time caring subscales of the Oberst Caregiving Burden Scale, which include 15 likert scale items. Scores range from 15-75. Higher scores indicate greater task difficulty and more time spent on each task, higher burden.
Change in Caregiver Burden as assessed by the Zarit Caregiver Burden Interview (ZBI)
The ZBI is a 12 item measure with higher scores representing higher feelings of burden; the range of summed scores is 0-48.

Full Information

First Posted
September 12, 2019
Last Updated
September 8, 2023
Sponsor
Johns Hopkins University
Collaborators
National Institute of Nursing Research (NINR)
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1. Study Identification

Unique Protocol Identification Number
NCT04090749
Brief Title
Caregiver Support in the Context of Multiple Chronic Conditions
Official Title
Caregiver Support in the Context of Multiple Chronic Conditions: Randomized Waitlist Control Trial
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Completed
Study Start Date
August 28, 2020 (Actual)
Primary Completion Date
May 31, 2022 (Actual)
Study Completion Date
May 31, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Johns Hopkins University
Collaborators
National Institute of Nursing Research (NINR)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This research is being done to learn whether services to the caregiver to provide emotional, instrumental and social support can improve quality of life and other outcomes. The Caregiver-Support program provides services that are not usually available to caregivers of persons with heart failure and other chronic conditions.
Detailed Description
Family caregivers who care for older adults living with multiple chronic conditions, including heart failure (HF), provide substantial cost savings to the US healthcare system. While caregiving can be meaningful and rewarding, extensive research also demonstrates high rates of chronic disease, fatigue and physiologic measures such as stress hormones among caregivers. Family caregivers are often left juggling caregivers' loved one's healthcare as well as caregivers' own. Unmet needs have been identified including increased stress, financial strain and social isolation, but interventions to address these needs in HF caregivers have had mixed results. Due to the limited impact of many caregiver interventions, experts have called for a greater understanding of the dynamic and contextual factors of family caregiving including resources, needs and social support with an increased focus on individualization of interventions for high-risk caregivers to improve outcomes.Following a mixed methods study to better understand these contextual factors and to address this gap between the evidence and uptake of proven strategies by caregivers, the study team has developed a resilience-promoting intervention to improve quality of life for family caregivers of individuals with multiple chronic conditions, including HF, Caregiver-Support. Caregiver-Support will help caregivers articulate statements of purpose in life, set goals to address fatigue and caregiver burden, provide instrumental support through a benefits check up and promote identification and increased connection with the caregiver's social network. The first phase of the study will be an open label pilot (N=5) followed by a single-masked, two-group, randomized trial (N=40) to test the feasibility and gauge an initial effect size of the intervention. Participants will be visited by study staff in participants' homes for all data collection and intervention visits. Participants will be randomized to receive either the immediate intervention group or the waitlist control group. In the waitlist control group, participants will receive usual care for the first 16 weeks (which is limited to printed materials provided in the clinic) and then begin the intervention. The intervention will consist of 5 in-home sessions with a nurse interventionist. Each participant will receive each intervention component but interventionists will systematically tailor content to the participants' goals based on protocols. All participants will be reassessed at 16 weeks (in person) and 32 weeks (by phone) by a research assistant (RA) masked to treatment condition. The primary outcome will be improvement in quality of life between baseline and 16 weeks. Other endpoints include group differences in fatigue, caregiver burden, self-reported and physiological measures of resilience up through 32 weeks after the intervention. The investigators will also examine the acceptability of the intervention using intervention compliance and participant satisfaction data.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Caregiver Burnout
Keywords
coping, resilience, quality of life

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Masking Description
The research assistant collecting data will be blinded to group assignment for each participant.
Allocation
Randomized
Enrollment
38 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Open Label Group
Arm Type
Experimental
Arm Description
In this arm, 5 participants will be enrolled in the intervention without blinding or randomization. The intervention and study delivery will be improved based on findings from this arm.
Arm Title
Waitlist Control
Arm Type
Other
Arm Description
The waitlist control group (n=20) will be provided written materials with community resources for caregivers during the first 16 weeks, then the intervention will begin.
Arm Title
Immediate Intervention
Arm Type
Experimental
Arm Description
The immediate intervention group (n=20) will receive the intervention during weeks 0-16. There will be assessment at week 32 to examine maintenance on primary and secondary outcomes.
Intervention Type
Behavioral
Intervention Name(s)
Caregiver-Support
Intervention Description
intervention incorporating 5 individualized, nurse-led, home-based sessions, with telephone check-ins and text reminders, according to participant preference. Caregiver-Support will help caregivers articulate statements of purpose in life, set goals to address fatigue and caregiver burden, provide instrumental support through a benefits check up and promote identification and increased connection with the caregiver's social network.
Primary Outcome Measure Information:
Title
Change in Quality of Life as assessed by the Short Form Health Survey
Description
The Short Form Health Survey (36 items) measures self-rated quality of life using 8 sub-scales. Items are scored on a 0-100 range, with total scores averaged for each subscale. The eight domains are also averaged to create an overall score from 0-100. Higher scores indicate a more favorable health state.
Time Frame
Baseline, 16 weeks and 32 weeks
Secondary Outcome Measure Information:
Title
Change in Fatigue as assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS)
Description
The PROMIS 7-item fatigue measure has a score range from 0-35 with higher scores indicating higher levels of fatigue.
Time Frame
Baseline, 16 weeks and 32 weeks
Title
Change in Caregiver Burden as assessed by the Oberst Caregiving Burden Scale
Description
The investigators will use the task difficulty and time caring subscales of the Oberst Caregiving Burden Scale, which include 15 likert scale items. Scores range from 15-75. Higher scores indicate greater task difficulty and more time spent on each task, higher burden.
Time Frame
Baseline, 16 weeks and 32 weeks
Title
Change in Caregiver Burden as assessed by the Zarit Caregiver Burden Interview (ZBI)
Description
The ZBI is a 12 item measure with higher scores representing higher feelings of burden; the range of summed scores is 0-48.
Time Frame
Baseline, 16 weeks and 32 weeks
Other Pre-specified Outcome Measures:
Title
Change in Interleukin 6 (ng/mL)
Description
Participants will wear a non-occlusive sweatpatch to collect interleukin 6. Higher levels of interleukin 6 suggest increased activation of inflammatory response and decreased resilience to stress.
Time Frame
Baseline, 16 weeks and 32 weeks
Title
Change in Interleukin 10 (pg/ml)
Description
Participants will wear a non-occlusive sweatpatch to collect interleukin 10. Higher levels of interleukin 10 suggest increased activation of the anti-inflammatory response and increased resilience to stress.
Time Frame
Baseline, 16 weeks and 32 weeks
Title
Change in resilience to stress as assessed by Heart Rate Variability
Description
Participants will touch a finger pad for 2-5 minutes to obtain heart rate variability. Heart rate variability is assessed through multiple calculations including: percentage of pairs of adjacent N-N intervals differing by more than 50 milliseconds (pNN50), high-frequency power (HF power), and low frequency to high frequency (LF/HF) ratio. Higher pNN50, HF power and LF/HF ratio levels suggest increased resilience to stress.
Time Frame
Baseline, 16 weeks and 32 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Primary family caregivers, will be identified by patients and providers in the Bridge Clinic must live with the patient or visit at least 3 times per week for the purposes of care provision provide support for at least one Instrumental Activity of Daily Living, Be able to speak English. Exclusion Criteria: Caregivers with terminal diagnosis will be excluded as goal-setting at end of life may be different than without a terminal diagnosis.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Martha Abshire, PhD
Organizational Affiliation
Johns Hopkins University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Johns Hopkins School of Nursing
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21205
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes

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Caregiver Support in the Context of Multiple Chronic Conditions

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