Collinge, W., Kahn, J., Walton, T., Kozak, L., Bauer-Wu, S., Fletcher, K., . . . Soltysik, R. (2013). Touch, caring, and cancer: Randomized controlled trial of a multimedia caregiver education program. Supportive Care in Cancer, 21, 1405–1414.

To evaluate the effect of family caregiver–provided massage, as instructed through a multimedia home-based training program, on patient symptom ratings, caregiver attitudes (confidence, self-esteem), and perceived stress

The experimental group received a DVD and written manual instructing caregivers on how to prepare for and safely practice providing massage and acupressure to patients with cancer in the home setting. Dyads were requested to practice at least three times per week for four weeks. Control group caregivers were asked to read to patients for the same frequency and duration. Caregiver/patient dyads were randomized to the intervention or control (reading) group for a four-week period, after which controls could opt to receive the intervention. An additional 16-week observation period followed.

• The sample included 97 caregiver/patient dyads.
• Age range of participants was 18–82 years.
• The caregiver sample was 56% male and 44% female; the patient sample was 76% male and 24% female.
• Patients with any type or stage of cancer were eligible.
• Participants had to be at least 18 years old and able to read and write English, Spanish, or Chinese.

• Multisite  
• Home setting
• Three U.S. cities: Boston, MA, Portland, ME, and Portland, OR

• Mutliple phases of care
• Palliative care

A randomized controlled trial design was used.

• Using a 1–10 scale, patients rated their level of pain, stress/anxiety, depression, fatigue, nausea, and patient-specified “other” symptoms prior to and 15 minutes after one of the weekly massage or reading sessions.
• Caregivers completed weekly reports on the number, content, and duration of the sessions.
• At baseline and four weeks, caregivers completed a seven-question investigator-designed survey on attitudes toward caregiving and the seven-item caregiver esteem subscale of the Caregiver Reaction Assessment; dyads completed the Perceived Stress Scale; and patients completed the Functional Assessment of Cancer Therapy–General.

Both control and intervention caregivers had good compliance with the protocol, and both experienced significant improvements in caregiver attitudes (ability to help patient feel better and worry about causing distress through touch). Intervention group caregivers reported increased self-efficacy in providing massage.

Patients in both groups reported significantly improved symptoms after each session. Over the four-week period, patients in the intervention group had significant mean decreases in symptom ratings for pain (p = 0.04), nausea (p = 0.02), and patient-specified symptoms (p = 0.02; these symptoms were not listed by the authors). There were some significant pre-/postsession symptom ratings improvements in the massage group when scores by week were compared, but no linear association of time and symptom trajectory was noted.

Both massage and reading interactions within patient/caregiver dyads appear to have a positive effect on caregiver attitudes and patient symptom ratings. Dyads utilizing massage based on the home instruction materials may receive more benefit regarding caregiver self-efficacy specific to that skill and greater symptom relief over time.

• The study had risk of bias (no control group).
• Given the improvements noted in both groups, it is possible that control group dyads intentionally (as a result of learning about the potential benefits of massage during the consent process) or unintentionally engaged in forms of touch that provided some benefits over the four-week observation period.

This study measured the benefits of massage on caregiver and patient outcomes as compared to a control (reading) and found both activities were potentially beneficial. The method by which the intervention group was instructed was innovative, multilingual, and widely reproducible, as it is offered through a DVD recording and written manual, and was tested in a sample that was very inclusive (open to all cancers and stages of adult patients who spoke three common languages, from three geographic sites in the United States). However, despite the study title, which leads the reader to believe that an aim of the study was to examine the effectiveness of the instruction method itself, this is not the case. A prior feasibility study was noted to pilot the included content, and a patient convenience sample (n = 18)  was noted to have tested the multimedia program for usability, but no report of testing the effectiveness of teaching the content in this manner versus any other method was reported. There were no implementation challenges or adverse events reported in the study (these were assessed by biweekly phone calls), and an oncology massage therapist made one home visit to the dyads to ensure the intervention was delivered safely. It is implied that the multimedia tool was an effective instruction method, but this was not explicitly studied. Study findings suggest that providing carers with any specific concrete way to intervene to help patients may be what is actually beneficial.