Web-based Program to Improve Self-management Among Veterans-caregiver Dyads

Launched by VA OFFICE OF RESEARCH AND DEVELOPMENT · Aug 14, 2023

Keywords

ClinConnect Summary

This clinical trial is exploring a new web-based program designed to help Veterans with chronic medical conditions and their informal caregivers better manage their health and reduce stress. Many Veterans deal with ongoing health issues which can be emotionally and physically challenging, and they often rely on caregivers—like family members or friends—for support. The goal of this study is to see if this online program can improve the way both Veterans and their caregivers handle the challenges of chronic illness, especially for those who may have trouble attending in-person appointments due to living in remote areas or facing financial difficulties.

To participate in this trial, Veterans need to have at least one common chronic condition, such as diabetes, heart disease, or depression, and must live with a primary caregiver. Participants will be screened to ensure they have internet access and are feeling overwhelmed in managing their health. Throughout the study, participants can expect to use the online program at their own pace, which aims to provide tools and strategies to cope with stress and improve self-management. It's important to note that certain individuals, such as those with serious cognitive issues or those experiencing interpersonal violence, will not be eligible to join. This trial could offer valuable insights into how to better support Veterans and their caregivers in managing their health.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Participants will be medically eligible if they have been diagnosed with at least one common chronic condition considered responsive to outpatient management as defined by being on the AHRQ list of Patient Quality Indicators, which are conditions that are considered responsive to high quality outpatient care.
• • The investigators will also include conditions that are disproportionately high among Veterans (pain, mental health conditions).
• * Based on the pilot study, the investigators anticipate this to include:
• • musculoskeletal pain
• • cardiovascular disease
• • diabetes
• • kidney disease
• • depression
• * Eligible participants will have at least one outpatient visit in the prior 12 months related to their diagnosis and have a primary caregiver who lives with the Veteran. Dyads will be excluded if either the Veterans or their caregiver:
• • 1) have an implantable cardioverter defibrillator
• • 2) are on hemodialysis
• • 3) have received an organ transplant or are waitlisted for one
• • 4) are undergoing chemotherapy or radiation for cancer
• • 5) have limited life expectancy as determined by the provider or hospice care
• • 6) have dementia or other major cognitive deficits
• • 7) have a substance use disorder (SUD), since supporting interpersonal relationships in SUDs require specialized training that is outside the scope of web-SUCCEED
• • 8) have a paid caregiver who provides 50% or more support to the Veteran
• • 9) are actively psychotic or suicidal. Due to content overlap, the investigators will exclude Veterans who have participated in the Stanford CDSMP program, and caregivers who have participated in the Building Better Caregiver program
• Exclusion Criteria:
• • Dyads deemed eligible with these criteria will be further screened by the study staff for internet use, self-management distress, and interpersonal violence.
• • a. Internet Use: The investigators will use the question that used in the pilot study, "How often do you use a computer?" The investigators will exclude dyads where either Veterans or caregivers answer "less than once a week."
• * b. Self-management Distress: The investigators will screen Veterans and caregivers for self-management distress using the same two-item measure that have been used for the pilot study of web-SUCCEED:
• • 1) How overwhelmed do you feel by the demands of living with your \[OR Veteran's\] health condition(s)?
• • 2) How often do you feel that you are failing in your routine to manage your \[OR Veteran's\] health conditions?" Respondents rate items from 1 (Not a problem) to 6 (A very serious problem), and scores are added. Dyads will be eligible if both individuals score a minimum of 2 and at least one scores \>3.
• • c. Interpersonal Violence: Veterans and caregivers will be separately screened with the question, "How do you and \[Veteran, caregiver\] handle stressful conversations or conflict?" If needed, this will be followed up with: "In the last year, has it gotten physical or have there been threats of physical force?". If the answer to the last question is "yes", dyads will not be eligible. Dr. Trivedi will assess for immediate safety, provide local resources, and involve authorities if appropriate. In the investigators' experience, this is a low likelihood event.