Improving Caregiver Quality of Life: From Clinician-Led to Digital Intervention
Jamie Jacobs, PhD, provides background on a digital intervention for caregivers of patients undergoing bone marrow transplant.
Caregivers of patients going through stem cell transplants often struggle with quality of life and require mental health support alongside the patient. The primary goal of an intervention at Massachusetts General Hospital was to enhance caregiver quality of life. In an interview with Targeted OncologyTM, Jamie Jacobs, PhD, discusses this intervention.
A few years ago, Jacobs explains, clinicians at Mass General began addressing these issues with a clinician-delivered intervention called BMT Care. This intervention involved one-on-one sessions with caregivers, delivered by a licensed, trained clinician before, during, and after a transplant.
While BMT Care showed positive results—caregivers reported improved quality of life and reduced caregiving burden—Jacobs and her team also identified a significant challenge: engagement. Caregivers found it difficult to participate in these prescheduled Zoom or in-person sessions, often expressing that adding another appointment to their busy schedules was overwhelming.
To make the benefits of these interventions more accessible and scalable, Jacobs and her team transitioned to a digital platform. This involved translating the entire BMT Care intervention into a self-guided mobile app, retaining all the original content. This allowed users to engage with the material conveniently from their homes, at times most relevant to their needs, and without the burden of prescheduled appointments.
Once the app was developed, Jacobs and her team tested its effectiveness in a randomized controlled trial. They enrolled 125 family and friend caregivers of patients with hematologic malignancies undergoing hematopoietic stem cell transplantation at the Mass General Cancer Center in Boston, Massachusetts. Participants were randomly assigned to either receive the BMT Care app or to a usual care control group.
Those in the usual care group met once with a transplant social worker, a common practice across cancer centers. Caregivers in the BMT Care app group received the app preloaded on a study iPad.
Various outcomes were assessed, including quality of life, caregiving burden, depression symptoms, anxiety symptoms, an post-traumatic stress symptom. Additionally, there were 2 outcomes of interest: caregivers' ability to cope with stress and self-efficacy for managing caregiving tasks and confidence in their caregiving role.
At 60 days post HSCT, the primary end point of caregiver quality of life, measured by the CareGiver Oncology QOL (CarGOQOL) questionnaire, showed significant improvement in the BMT-CARE App group compared to UC (76.2 vs 69.9, P =.006), surpassing the clinically meaningful difference. The intervention group also reported significantly lower caregiving burden, depression symptoms, and PTSD symptoms, alongside improved coping skills. No significant differences were observed in anxiety symptoms or self-efficacy.
