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Intervention: Using the COPE Intervention for Hospice Caregivers

Principal Investigator: Susan C. McMillan, Ph.D., A.R.N.P.

Caregiver Intervention Description

A. The intervention was offered in three face to face sessions over a 7 to 9 day period. The first meeting was 45 minutes, and the second and third were 30 minutes each. This 7 to 9 day time period was chosen because of the short lengths of stay of cancer patients in hospice care; a longer intervention would not have been effective for half the patients.

At the first session, the nurse interventionist explained the COPE intervention and introduced the caregiver to the COPE manual. During that meeting, the interventionist reviewed the management of the highest priority symptom that the patient had (pain, constipation or dyspnea). Before leaving, the interventionist asked the caregiver to review the chapter for the second highest priority symptom in order to be able to discuss its management at the second visit.

At the second visit, the interventionist asked about the success of the management of the first problem and then reviewed management of the second problem. Before leaving, the interventionist asked the caregiver to review the management of the third priority problem. If the patient had only two of the target symptoms, the caregiver was asked to review both of the earlier symptoms that had been covered.

At the third meeting, the interventionist asked the caregiver about success with managing the previous two problems and went on to discuss the third problem (if appropriate). At the end of this meeting, the interventionist terminated the relationship.

For the caregivers, the intervention significantly improved their quality of life, decreased burden from caregiving tasks and their distress from patient symptoms. For the patients, the intervention significantly decreased their perceptions of overall symptom distress.

Key search terms: Hospice caregivers, COPE, skills training, cancer

2. Intervention Materials

The Homecare Guide for Advanced Cancer published by the American Cancer Society and available on their website (Cancer.org) was given to each of the caregivers. This manual has an introduction that explains the COPE intervention and then chapters that are organized in such a way as to facilitate finding information quickly. There is no expectation that the caregivers read the entire manual or even an entire chapter. Rather, the book is organized to allow the caregiver to flip to the section that they need to get questions answered.

To obtain a copy of the Research Intervention Manual, contact Melissa Leggatt at MLeggatt@health.usf.edu.

3. Implementing the Intervention

The intervention was offered to the family caregivers by experienced hospice RN’s. While there is no training program, the Research Intervention Manual includes the training plan for the RN’s and some scenarios that will allow them to practice giving the intervention.

The cost of offering the intervention is not known. We offered three days of training. So costs could be estimated by adding the cost of the interventionist for four days.

Hospice patients with cancer tend to be referred late so that the intervention needs to be started at admission if possible.

4. For more information

McMillan, S.C., Small, B.J., Weitzner, M., Schonwetter, R., Tittle, M., Moody, L. & Haley, W.E. (2006). Impact of Coping Skills Intervention with Family Caregivers of Hospice Patients with Cancer: A Randomized Clinical Trial. Cancer, 106(1), 214-222.

To read about the patient outcomes, see the following:

McMillan, S.C. & Small, B.J. (2007). Using the COPE Intervention for Family Caregivers to Improve Patients’ Symptoms: A Clinical Trial. Oncology Nursing Forum, 34 (2), 313-318.

Moody, L.E., & McMillan, S.C. (2003). Dyspnea and quality of life indicators in hospice patients and their caregivers. Health and Quality of Life Outcomes 1:9, 1-7.

McMillan, S.C., & Moody, L.E. (2003) Hospice patient and caregiver congruence in reporting patients’ symptom intensity. Cancer Nursing, 26(2),113-118.

McMillan, S.C., & Weitzner, M. A. (2003). Methodological issues in collecting data from debilitated patients near the end of life. Oncology Nursing Forum, 30(1), 123-129.

McMillan, S.C. (2002). Presence and severity of constipation in hospice patients with advanced cancer. American Journal of Hospice and Palliative Care, 19(6), 426-430

McMillan, S.C., & Small, B. (2002). Symptom distress and quality of life in hospice patients with cancer. Oncology Nursing Forum, 29(10), 1421-1428.

Allen, R., Haley, W.E., McMillan, S.C., & Small, B.J. (2002). Pain reports by older hospice cancer patients and family caregivers: The role of cognitive functioning. The Gerontologist, 42(4), 507-513.

Moody, L.E., & McMillan, S.C. (2002). Maintaining data integrity in randomized clinical trials. Nursing Research, 51(2), 129-133.