Terry Badger, PhD, RN, PMHCNS-BC, FAAN, professor and director of the community and systems health science division at the University of Arizona College of Nursing, has focused on depression in chronic illness since her days working at a VA clinic. Considering that depression is the world’s most common mental health disorder, she was surprised to find that research was scant about the connection between depression and interpersonal relationships of patients and their caregivers.
That awareness led directly to her clinical interest in psychosocial oncology interventions with cancer survivors and their families. Funded by the American Cancer Society, Badger’s current research focuses on interventions intended to strengthen the social and spiritual well-being of Latinas and their caregivers. Unique in two ways, the study aims to improve the care of a historically underserved population and it employs a surprising familiar technology to deliver its interventions: the telephone.
Why did you focus on the Latina population?
When we started working with our Latina population nobody was thinking about how to deliver care to Hispanic women and their caregivers. Typically, patients who were really depressed would be referred to face-to-face support groups, but at the time we didn’t have any for Spanish speakers. Latinas are a growing and particularly vulnerable population with regard to breast cancer, because they tend to be diagnosed at later stages, to be sicker and have fewer easily accessible resources to deal with their psychological distress. If we recommended supportive care services, only about 25 percent of people would come, and if you referred them to a psychiatrist or advanced practice psych nurse, only about 45 percent would come due to stigma or travel concerns. I culturally tailored the program to serve their needs.
Why focus on patients and their family caregiver?
Cancer is not just the patients’ illness. It’s really a family disease, because it alters roles, responsibilities and expectations. During various phases of the cancer journey, caregivers make tremendous changes in their lives – they may change their work hours or they may have to leave their work entirely. It impacts the entire family. Whether you yourself have the illness or if you love somebody with chronic illness, there can be lots of depression and anxiety.
Why did you choose the telephone as the intervention delivery device?
We needed to develop a way to deliver psychosocial oncology services counseling and education to survivors and their caregivers in a very accessible way. We started these studies in 2000 and we thought about computers and other devices, but at that time the technology wasn’t right. I realized that people with very low economic means may not have a computer and even if they do they might not have internet access. But we found that even people who are very limited will have a cell phone with some minutes on it. That’s how we developed the study.
How does the study work?
Once people are enrolled, we call them about once a week for about 30 minutes. We provide the intervention and the treatment and of course we measure their progress along the way. What we learned is that we are able to effectively deal with their anxiety, depression and stress, but also that when we deal with those factors, other symptoms like fatigue and pain aren’t as severe. We found that our patients and their caregivers love the fact that they don’t have to arrange for childcare or pay for transportation. In other words, there are absolutely no barriers to accessing the care they need. One woman told me, ‘Before you even talk to me, just the thought of you calling me once a week to ask me how I am has made me feel better.’ The human contact means a lot to them and the nice thing about it is how it colors their whole view of their care at the University of Arizona Cancer Center because they believe, ‘Wow, I’m really cared about.’
How will the outcome of the study improve lives?
We’ll show the intervention was effective in symptom management, symptom distress in improving social wellbeing, spiritual wellbeing, decreasing depression, anxiety and other negative symptoms. I hope we’re reaching a point where we can look at changing practice. For example, in the future the Cancer Center could routinely offer this service to patients. They have supportive care for healing, but again, it’ss premised a lot on face-to-face. In the future this kind of telephone intervention could be offered as part of the care package.
How do you see your work influencing the course of nursing education?
When anybody is dealing with a disease or other health issues, it really does affect everyone within their circle. The work we’re doing is really about the bigger picture. Right now, over half the care that is given to a cancer patient is by their home caregiver, not by the providers. In educating future nurses, we need to think through how we can help them learn what they need to learn to help these people live their best lives.
Media contact: Jason Gelt, Communications and Content Specialist