||5R01CA255265-03 Interpret this number
||H. Lee Moffitt Cancer Ctr & Res Inst
||Efficacy of a Mindfulness-Based Stress Management Program for Allogeneic Hct Caregivers
Caring for an allogeneic hematopoietic stem cell transplant (HCT) patient is a significant responsibility,
involving a commitment to be available 24/7 up to at least 100 days post-transplant to provide emotional and
physical support. Informal family caregivers of HCT patients often experience significant role changes that can
conflict with other responsibilities (e.g., work, child rearing). Caregivers often report high burden and poor
mental health, which can have an adverse impact on patient health outcomes, including increased anxiety,
depression, and decreased patient survival. However, some research suggests that caregivers may benefit
when they receive adequate support and when given the opportunity for growth and meaning-making. Despite
this, few comprehensive and proactive caregiver support programs exist. Mindfulness facilitates the ability to
shift attention to experiences purposefully, with a sense of acceptance (as opposed to trying to change or react
to it). Active mechanisms of mindfulness (e.g., improved attention, emotion regulation, decentering) combined
with the unique circumstances of HCT caregivers, suggest that approaching thoughts/emotions/sensations via
mindfulness may convey benefits above and beyond what is found in other treatment approaches. Our multi-
disciplinary team systematically developed a 6-week mindfulness-based intervention for allogeneic HCT
caregivers – FOCUS (Focusing On mindfulness for Caregivers Under Stress). FOCUS spans the course of
patient treatment, with session 1 occurring prior to transplant, sessions 2-3 taking place immediately following
transplant, and sessions 4-6 occurring post-discharge. Pilot testing revealed that FOCUS was highly feasible
and acceptable for allogeneic HCT caregivers and useful for managing stress. Significant decreases in
negative affect and increases in mindfulness, post traumatic growth, and mental health symptoms were
observed from baseline to end of treatment; findings were maintained through the 1-month follow-up. This
project builds on our pilot study by randomizing caregivers (N=270) to one of three treatment conditions:
FOCUS, Healthy Living (HL), and Usual Care (UC). This three-arm design will allow us to rigorously test if
FOCUS is more efficacious than both HL (attention placebo condition matched to FOCUS on time and contact)
and UC (attention control condition). Self-report assessments will occur at baseline, end of treatment, and 2-
and 6-months post-treatment. Biomarker data will be collected via hair cortisol concentrations, and daily diaries
will assess fluctuating variables (e.g., affect, state mindfulness). We anticipate mindfulness to ultimately reduce
caregiver burden (primary outcome) via measured mechanisms (e.g., reduced stress). We expect patient
distress and healthcare utilization to be both directly and indirectly impacted via caregiver participation in
FOCUS. This proposal aligns with a recent call from NIH to develop and test interventions for cancer
caregivers that also improve patient health outcomes. If ultimately proven efficacious, future research includes
plans for dissemination/implementation, as well as extension to other cancer caregiver populations.
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