Intervenciones psicológicas en cuidadores primarios de pacientes con trasplante de células hematopoyéticas: Revisión descriptiva

Contenido principal del artículo

L. Brenes-Mesa
https://orcid.org/0000-0001-9789-786X
L.M. Valero-Saldaña
https://orcid.org/0000-0001-7225-3486
B. Acosta-Maldonado
https://orcid.org/0000-0003-4692-0710
M.R. Rodríguez-Aguilar
https://orcid.org/0000-0002-2491-5040
J.L. Aguilar-Ponce
https://orcid.org/0000-0002-9960-8547
L. Rivera-Fong
https://orcid.org/0000-0003-4155-9954

Resumen

Introducción: El ser cuidador primario informal de un paciente con indicación médica de trasplante de células progenitoras hematopoyéticas puede tener consecuencias negativas en su salud mental y calidad de vida.


Objetivo: Describir las intervenciones psicológicas disponibles para el cuidador primario de pacientes sometidos a trasplante de células hematopoyéticas.


Metodología: Se realizó una búsqueda sistematizada de los últimos 10 años con los términos MeSH: psychotherapy AND caregive AND stem cell transplantation en las principales bases de datos médicas y de psicología, para su análisis se empleó la estrategia: Problema, Intervención, Comparación y Outcomes (PICO).


Resultados: Se identificaron 122 artículos, de ellos diez cumplieron los criterios de inclusión. Las intervenciones provenían de profesionales de enfermería o trabajo social; el 50% incluyó diadas (paciente y cuidador primario), mostraron una tendencia de duración corta, enfocada al periodo posterior al trasplante. Se basan en el entrenamiento en solución de problemas, manejo de estrés, atención plena y expresión emocional. Las intervenciones lograron la disminución de la depresión, ansiedad y estrés en el cuidador; pero no alcanzaron permanencia en la significancia estadística de dichos restablecimientos.


Discusión: De acuerdo con lo observado en las publicaciones y por su impacto positivo en la salud mental, se recomienda la implementación de intervenciones psicológicas en cuidadores de pacientes con trasplante de células progenitoras hematopoyéticas.


Conclusión: El apoyo psicológico brindado al cuidador generalmente es de profesionales de la salud que no pertenecen al área de la psicología, con resultados clínicos favorables en las etapas más críticas de su estado mental.

Detalles del artículo

Dimensions citation

MÉTRICAS

 

Citas

1. Health Resources and Services Administration HRSA, Blood Stem Cell. EE. UU.: Transplant Activity Report; c2020. https://bit.ly/3dPDt4H

2. Kaushasky K, Lichtman MA, Prchal JT, Levi MM, Press OW, Burns LJ, et al. Williams Hematology. 9th ed. EE. UU.: McGraw-Hill; 2016.

3. World Health Organization. Geneva, Switzerland: Haematopoietic Stem Cell Transplantation HSCtx; c2020. https://bit.ly/31sRbW7

4. Territo MC, Casciato DA. Manual de Oncología Clínica. 7th ed. Pensilvania, EUA: Wolters Kluwer/ Lippincott Williams y Wilkins; 2013.

5. National Cancer Institute. EE.UU.: Stem cell transplants in cancer treatment; 2015. https://bit.ly/3jhxKW9

6. Applebaum AJ, Bevans M, Son T, Evans K, Hernandez M, Giralt S, et al. A scoping review of caregiver burden during allogeneic HSCT: Lessons learned and future directions. Bone Marrow Transplant. 2016; 51(11): 1416-22. https://doi.org/10.1038/bmt.2016.164

7. Díaz-Rubio E, García-Conde J. Oncología Clínica Básica. España: Arán Ediciones; 2000.

8. Majhail NS, Rizzo JD, Hahn T, Lee SJ, McCarthy PL, Ammi M, et al. Pilot study of patient and caregiver out-of-pocket costs of allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2013; 48(6): 865-71. https://doi.org/10.1038/bmt.2012.248

9. Aslan O, Kav S, Meral C, Tekin F, Yesil H, Ozturk U, et al. Needs of lay caregivers of bone marrow transplant patients in Turkey: A multicenter study. Cancer Nurs. 2006; 29(6): E1-7. https://doi.org/10.1097/00002820-200611000-00014

10. Beattie S, Lebel S.The experience of caregivers of hematological cancer patients undergoing a hematopoietic stem cell transplant: a comprehensive literature review. Psychooncology. 2011; 20(11): 1137-50. http://doi.org/10.1002/pon.1962

11. Rivera-Fong L, Landa-Ramírez E, Valero-Saldaña LM, Riveros-Rosas A. Efectos de una intervención cognitivo conductual y actividad física sobre variables médicas y psicológicas en pacientes sometidos a trasplante hematopoyético de células madre. Psicooncología. 2014; 11(2-3): 217-31. https://doi.org/10.5209/rev_PSIC.2014.v11.n2-3.47384

12. Bevans M, Wehrlen L, Prachenko O, Soeken K, Zabora J, Wallen GR. Distress screening in allogeneic hematopoietic stem cell (HSCT) caregivers and patients. Psychooncology. 2011; 20(6): 615-22. https://doi.org/10.1002/pon.1906

13. Hoffman LH, Szkrumelak N, Sullivan AK. Psychiatric assessment of candidates for bone marrow transplantation: a psychodynamically-oriented approach. Int J Psychiatry Med. 1999; 29(1): 13-28. https://doi.org/10.2190/1c24-h366-cgc9-v1pw

14. Rodrigue JR, Windows MR, Baz MA. Caregivers of lung transplant candidates: Do they benefit when the patient is receiving psychological services? Prog Trasnplant. 2006; 16(4): 336-42. https://bit.ly/36NtH1m

15. Ross A, Yang L, Klagholz SD, Wehrlen L, Bevans MF. The relationship of health behaviors with sleep and fatigue in transplant caregivers. Psychooncology. 2016; 25(5): 506–12. https://doi.org/10.1002/pon.3860

16. Simoneau TL, Kilbourn K, Spradley J, Laudenslager ML. An evidence-based stress management intervention for allogeneic hematopoietic stem cell transplant caregivers: Development, feasibility and acceptability. Support Care Cancer. 2017; 25(8): 2515-23 https://doi.org/10.1007/s00520-017-3660-5

17. Wei L, Li J, Cao Y, Xu J, Qin W, Lu H. Quiality of life and care burden in primary caregivers of liver transplantation recipients in China. Medicine. 2018; 97(24): e10993. https://doi.org/10.1097/MD.0000000000010993

18. Foster LW, McLellan L, Rybicki L, Dabney J, Copelan E, Bolwell B. Validating the positive impact of in-hospital lay care-partner support on patient survival in allogeneic BMT: A prospective study. Bone Marrow Transplant. 2013; 48(5): 671–7. https://doi.org/10.1038/bmt.2012.208

19. Gemmill R, Cooke L, Williams AC, Grant M. Informal caregivers of hematopoietic cell transplant patients: a review and recommendations for interventions and research. Cancer Nurs. 2011; 34(6): E13-21. https://doi.org/10.1097/NCC.0b013e31820a592d

20. Sundaramurthi T, Wehrlen L, Friedman E, Thomas S, Bevans M. Hematopoietic stem cell transplantation recipient and caregiver factors affecting length of stay and readmission. Oncol Nurs Forum. 2017; 44(5): 571–9. https://doi.org/10.1188/17.onf.571-579

21. Beattie S, Lebel S, Tay J. The influence of social support on hematopoietic stem cell transplantation survival: A systematic review of literature. PLoS One. 2013; 8(4): 1–6. https://doi.org/10.1371/journal.pone.0061586

22. Rodrigue JR, Pearman TP, Moreb J. Morbidity and mortality following bone marrow transplantation: predictive utility of pre-BMT affective functioning, compliance, and social support stability. Int J Behav Med. 1999; 6(3): 241–54. https://doi.org/10.1207/s15327558ijbm0603_3

23. Posluszny DM, Bovbjerg DH, Agha ME, Hou JZ, Raptis A, Boyiadzis MM, et al. Patient and family caregiver dyadic adherence to the allogeneic hematopoietic cell transplantation medical regimen. Psychooncology. 2017; 27(1): 354–8. https://doi.org/10.1002/pon.4393

24. Wulff-Burchfield EM, Jagasia M, Savani BN. Long-term follow-up of informal caregivers after allo-SCT: A systematic review. Bone Marrow Transplant. 2013; 48(4): 469–73. https://doi.org/10.1038/bmt.2012.123

25. Blum K, Sherman DW. Understanding the experience of caregivers: A focus on transitions. Semin Oncol Nurs. 2010; 26(4): 243–58. https://doi.org/10.1016/j.soncn.2010.08.005

26. Northouse L, Williams AL, Given B, McCorkle R. Psychosocial care for family caregivers of patients with cancer. J Clin Oncol. 2012; 30(11): 1227–34. https://doi.org/10.1200/JCO.2011.39.5798

27. Gerhart JI, Asvat Y, Lilis TA, Fung H, Grosse J, Hobfoll SE. The impact of posttraumatic stress symptoms on social support and social conflict during hematopoietic stem cell transplant. J Psychosoc Oncol. 2018; 36(3): 304-18. https://doi.org/10.1080/07347332.2018.1425793

28. Langer SL, Yi JC, Storer BE, Syrjala KL. Marital adjustment, satisfaction and dissolution among hematopoietic stem cell transplant patients and spouses: A prospective, five-year longitudinal investigation. Psychooncology. 2010; 19(2): 190–200. https://doi.org/10.1002/pon.1542

29. Simoneau TL, Mikulich-Gilbertson SK, Natvig C, Kilbourn K, Spradley J, Grzywa-Cobb R, et al. Elevated peri-transplant distress in caregivers of allogeneic blood or marrow transplant patients. Psychooncology. 2013; 22(9): 2064-70. https://doi.org/10.1002/pon.3259

30. Bishop MM, Beaumont JL, Hahn EA, Cella D, Andrykowski MA, Brady MJ, et al. Late effects of cancer and hematopoietic stem-cell transplantation on spouses or partners compared with survivors and survivor-matched controls. J Clin Oncol. 2007; 25(11): 1403–11. https://doi.org/10.1200/JCO.2006.07.5705

31. Bevans MF, Ross A, Wehrlen L, Klagholz SD, Yang L, Childs R, et al. Documenting stress in caregivers of transplantation patients: Initial evidence of HPA dysregulation. Stress. 2016; 19(2): 175–84. https://doi.org/10.3109/10253890.2016.1146670

32. Foxall MJ, Gaston-Johansson F. Burden and health outcomes of family caregivers of hospitalized bone marrow transplant patients. J Adv Nurs. 1996; 24(5): 915–23. https://doi.org/10.1111/j.1365-2648.1996.tb02926.x

33. Gaston-Johansson F, Lachica EM, Fall-Dickson JM, Kennedy MJ. Psychological distress, fatigue, burden of care, and quality of life in primary caregivers of patients with breast cancer undergoing autologous bone marrow transplantation. Oncol Nurs Forum. 2004; 31(6): 1161–9. https://doi.org/10.1188/04.onf.1161-1169

34. Given B, Wyatt G, Given C, Sherwood P, Gift A, DeVoss D, et al. Burden and depression among caregivers of patients with cancer at the end of life. Oncol Nurs Forum. 2004; 31(6): 1105–17. https://doi.org/10.1188/04.ONF.1105-1117

35. Son T, Lambert S, Jakubowski A, DiCicco-Bloom B, Loiselle CG. Adaptation of coping together - a self-directed coping skills intervention for patients and caregivers in an outpatient hematopoietic stem cell transplantation setting: a study protocol. BMC Health Serv Res. 2018; 18(1): 669. https://doi.org/10.1186/s12913-018-3483-1

36. Vinci C, Reblin M, Jim H, Pidala J, Bulls H, Cutolo E. Understanding preferences for a mindfulness-based stress management program among caregivers of hematopoietic cell transplant patients. Complement Ther Clin Pract. 2018; 33: 164–9. https://doi.org/10.1016/j.ctcp.2018.10.007

37. Beattie S, Lebel S, Petricone-Westwood D, Wilson KG, Harris C, Devins G, et al. Balancing give and take between patients and their spousal caregivers in hematopoietic stem cell transplantation. Psychooncology. 2017; 26(12): 2224–31. https://doi.org/10.1002/pon.4340

38. Manne S, Mee L, Bartell A, Sands S, Kashy DA. A randomized clinical trial of a parent-focused social-cognitive processing intervention for caregivers of children undergoing hematopoetic stem cell transplantation. J Consult Clin Psychol. 2016; 84(5): 389–401. https://doi.org/10.1037/ccp0000087

39. Sands SA, Mee L, Bartell A, Manne S, Devine KA, Savone M, et al. Group-Based trajectory modeling of distress and well-being among caregivers of children undergoing hematopoetic stem cell transplant. J Pediatr Psychol. 2017; 42(3): 283–95. https://doi.org/10.1093/jpepsy/jsw064

40. Manterola DC, Zavando MD. Cómo interpretar los “Niveles de Evidencia” en los diferentes escenarios clínicos. Rev Chil Cir. 2009; 61(6): 582-95. http://dx.doi.org/10.4067/S0718-40262009000600017

41. Laudenslager ML, Simoneau TL, Kilbourn K, Natvig C, Philips S, Spradley J, et al. A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: Effects on distress. Bone Marrow Transplant. 2015; 50(8): 1110-18. https://doi.org/10.1038/bmt.2015.104

42. Laudenslager ML, Simoneau TL, Philips S, Benitez P, Natvig C, Cole S. A randomized controlled pilot study of inflammatory gene expression in response to a stress management intervention for stem cell transplant caregivers. J Behav Med. 2016; 39(2): 346–54. https://doi.org/10.1007/s10865-015-9709-3

43. Bevans M, Castro K, Prince P, Shelburne N, Prachenko O, Loscalzo M, et al. An individualized dyadic problem-solving education intervention for patients and family caregivers during allogeneic hematopoietic stem cell transplantation: a feasibility study. Cancer Nurs. 2010; 33(2): E24-32 https://doi.org/10.1097/NCC.0b013e3181be5e6d

44. Bevans M, Wehrlen L, Castro K, Prince P, Shelburne N, Soeken K, et al. A problem-solving education intervention in caregivers and patients during allogeneic hematopoietic stem cell transplantation. J Health Psychol. 2014; 19(5): 602-17 https://doi.org/10.1177/1359105313475902

45. Stonnington CM, Darby B, Santucci A, Mulligan P, Pathuis P, Cuc A, et al. A resilience intervention involving mindfulness training for transplant patients and their caregivers. Clin Transplant. 2016; 30(11): 1466-72. https://doi.org/10.1111/ctr.12841

46. Langer SL, Kelly TH, Storer BE, Hall SP, Lucas HG, Syrjala KL. Expressive talking among caregivers of hematopoietic stem cell transplant survivors: Acceptability and concurrent subjective, objective, and physiologic indicators of emotion. J Psychos Oncol. 2012; 30(3): 294-315 https://doi.org/10.1080/07347332.2012.664255

47. Cormier S, Nurius SP, Osborn CJ. Interviewing and change strategies for helpers. 8th ed. EE. UU.: Cengage Learning; 2016.

48. Caqueo-Urízar A, Alessandrini M, Urzúa A, Zendjidjian X, Boyer L, Williams DR. Caregiver’s quality of life and its positive impact on symptomatology and quality of life of patients with schizophrenia. Health Qual Life Outcomes. 2017; 15: 76. https://doi.org/10.1186/s12955-017-0652-6

49. Ready RE, Mathews M, Leserman A, Paulsen JS. Patients and caregiver quality of life in Huntington’s disease. Mov Disord. 2008; 23(5): 721-6. https://doi.org/10.1002/mds.21920

50. Cohen GL, Garcia J, Goyer JP. Turning point: Targeted, tailored, and timely psychological intervention. In Elliot AJ, Dweck CS, Yeager DS, editors. Handbook of competence and motivation: Theory and application New York. EE. UU.: The Guilford Press; 2017. p. 657-86. https://bit.ly/31MSj7d

51. Ambriz-López MC, Villalobos-Arámbula LM, Gallegos-Torres RM, Xeque-Morales AS, Hernández-Castañón MA, Palomé-Vega G. Perfil del cuidador principal y su relación con el cuidado del personal de enfermería. Rev. Enfer. Inst. Mex. Seguro Soc. 2014; 22(3): 123-9. https://bit.ly/3muqLLK

52. Laudenslager ML, Simoneau TL, Mikulich-Gilberston SK, Natvig C, Brewr BW, Sannes TS, et al. A randomized control trial of stress management for caregivers of stem cell transplant patients: Effect on patient quality of life and caregiver distress. Psycho-Oncology. 2019; 28: 1614-23. https://doi.org/10.1002/pon.5126

53. Manne S, Mee L, Bartell A, Sands S, Kashy DA. A randomized clinical trial of a parent-focused social-cognitive processing intervention for caregivers of children undergoing hematopoietic stem cell transplantation. Journal of Consulting and Clinical Psychology. 2016; 84(5): 389-401. https://doi.apa.org/doi/10.1037/ccp0000087

54. El-Jawahri A, Jacobs JM, Nelson AM, Traeger L, Greer JA, Nicholson S, et al. Multimodal psychosocial intervention for family caregivers of patients undergoing hematopoietic stem cell transplantation: A randomized clinical trial. Cancer. 2020; 0: 1-8. https://doi.org/10.1002/cncr.32680

55. Liu YM, Wen YC, Weng PY, Jaing TH, Chen SH. Exploring the concerns and experiences of parents of children scheduled to receive haematopoietic stem cell transplant. J. Adv. Nurs. 2020; 76(7). https://doi.org/10.1111/jan.14386