Jacobs Jamie M, Traeger Lara, Freese Madison, Barata Anna, Newcomb Richard, Rabideau Dustin, Horick Nora, DeFilipp Zachariah, Chen Yi-Bin, Gray Tamryn, Pepper Julia, Caruso Ella, Amonoo Hermioni L, Lee Stephanie J, Greer Joseph A, Temel Jennifer S, El-Jawahri Areej
Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
J Clin Oncol. 2025 Jul 10;43(20):2265-2275. doi: 10.1200/JCO-25-00713. Epub 2025 May 30.
Family and friend caregivers of patients undergoing hematopoietic stem-cell transplantation (HSCT) struggle with immense caregiving burden, leading to substantial quality of life (QOL) impairments and psychological distress. Yet, interventions to address caregivers' needs are limited.
We conducted a randomized controlled trial of a psychosocial digital application (BMT-CARE App) versus usual care for adult caregivers of patients with hematologic malignancies undergoing HSCT. The BMT-CARE App included five modules combining psychoeducation and evidence-based behavior change strategies. Participants completed self-report measures at baseline and day 60 post-HSCT. The primary end point was QOL at day 60 assessed by the CareGiver Oncology QOL (CarGOQOL) measure. We also assessed caregiving burden (Caregiver Reaction Assessment), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), and post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist [PCL-5]). We used analysis of covariance adjusting for baseline scores to assess the effect of the intervention on study outcomes.
Between February 2023 and July 2024, we enrolled 125 of 174 approached caregivers (71.8%). Participants assigned to the BMT-CARE App used the app for a median of 146.9 minutes (range, 0-384.8). At day 60, BMT-CARE App caregivers reported clinically and significantly better QOL than those assigned to usual care (adjusted means = 76.3 69.9, = .006). BMT-CARE App participants also reported significantly lower caregiving burden (11.2 12.3, = .023), depression (3.8 5.6, = .002), and PTSD symptoms (26.1 31.3, = .012). The groups did not differ significantly in anxiety symptoms at day 60.
The BMT-CARE App led to significantly improved QOL, caregiving burden, depression, and PTSD symptoms among HSCT caregivers. This intervention should be tested in a multicenter study with a diverse HSCT caregiver population to determine generalizability and scalability.
接受造血干细胞移植（HSCT）患者的家庭和朋友护理人员承受着巨大的护理负担，导致生活质量（QOL）大幅受损和心理困扰。然而，满足护理人员需求的干预措施有限。
我们对一款心理社会数字应用程序（BMT-CARE应用程序）与常规护理进行了一项随机对照试验，对象为接受HSCT的血液系统恶性肿瘤患者的成年护理人员。BMT-CARE应用程序包括五个模块，结合了心理教育和基于证据的行为改变策略。参与者在基线和HSCT后第60天完成自我报告测量。主要终点是通过护理人员肿瘤生活质量（CarGOQOL）测量在第60天评估的生活质量。我们还评估了护理负担（护理人员反应评估）、焦虑和抑郁症状（医院焦虑和抑郁量表）以及创伤后应激障碍（PTSD）症状（PTSD检查表[PCL-5]）。我们使用协方差分析并调整基线分数来评估干预对研究结果的影响。
在2023年2月至2024年7月期间，我们纳入了174名被邀请的护理人员中的125名（71.8%）。被分配到BMT-CARE应用程序的参与者使用该应用程序的中位数时间为146.9分钟（范围为0 - 384.8分钟）。在第60天，BMT-CARE应用程序组的护理人员报告的生活质量在临床和统计学上显著优于分配到常规护理组的人员（调整后均值 = 76.3对69.9，P = .006）。BMT-CARE应用程序组的参与者还报告护理负担显著更低（11.2对12.3，P = .023）、抑郁症状（3.8对5.6，P = .002）和PTSD症状（26.1对31.3，P = .012）。两组在第60天的焦虑症状方面没有显著差异。
BMT-CARE应用程序使HSCT护理人员的生活质量、护理负担、抑郁和PTSD症状得到显著改善。这种干预措施应在一项针对不同HSCT护理人员群体的多中心研究中进行测试，以确定其普遍性和可扩展性。
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