Re: Telephone Intervention With Family Caregivers of Stroke Survivors After Rehabilitation
To the Editor:
Grant et al1 find that healthcare professionals are challenged to develop effective intervention programs that will assist family caregivers to effectively manage caregiver problems. It is possible these changes may have beneficial effects for stroke survivors who are indeed sensitive and reactive to caregiver coping behavior. Family members arranged to talk with the research nurse later in the day if they were busy with other activities. Perhaps this flexibility in rescheduling telephone contacts allowed caregivers to better focus and develop more rational problem-solving skills in addressing problems.
This strategy is suggested by a report that pausing before taking action in stress management relative to usual care of mental stress–induced myocardial ischemia in men has substantial and immediate clinical and economic benefits. This hypothesis is supported by (1) the association of the reduction of blood pressure with longer, less recurrent speech hesitation pauses (about 2 seconds); (2) a report linking 3-second intertrial intervals with integration of target and body-part information in the premotor cortex when planning action; (3) the association of 2- to 4-second periods of rest with significant cognitive activity2; and (4) a 2.5- to 3-second delay period for inhibition shaping the temporal flow of information in the prefrontal cortex.3
These findings give precise, objective methods to facilitate problem-solving training1 and save travel time by remote acquisition of temporal features of expressive activity in spontaneous dialogues, reflecting neuronal activity and firing.2,4
Grant JS, Elliott TR, Weaver M, Bartolucci AA, Giger JN. Telephone intervention with family caregivers of stroke survivors after rehabilitation. Stroke. 2002; 33: 2060–2065.
Friedman EH. Neurobiology of psychosocial treatment of mental stress-induced myocardial ischemia in men. Am J Cardiol. 2002; 90: 86–87. Letter.
Toon PD. Using telephones in primary care: A significant proportion of consultations might take place by phone. BMJ. 2002; 324: 1230–1231.
Dr Friedman was helpful in sharing empirical evidence from other studies regarding precise and objective methods that illustrate the value of pausing (in this case, rescheduling) before taking action in stressful situations, such as caregiving. How many times has each of us benefited from using this strategy to manage difficult situations and reduce anxiety?
Perhaps pausing is what we need to do in evaluating cost-effective interventions, such as the telephone. Dr Friedman cited literature that recognizes the telephone as a potential cost-effective strategy to use in addressing some problems experienced by patients and their families. As healthcare providers, all of us must examine the way we deliver care and continue to be creative in developing programs that assist family members to cope with the functional, cognitive, and emotional consequences of an illness such as a stroke, and help them to adapt therapeutic regimens to the realities of social, environmental, and familial demands. Using the telephone for health care professionals who talk with family members about their problems may be one strategy.
In evaluating intervention programs, investigators must evaluate not only statistical significance but also perceived clinical usefulness to research participants. In evaluating the usefulness of the intervention, family caregivers who completed the social problem-solving telephone partnership program were mailed a letter, asking them to tell us what they had learned by participating in the program. The participants’ responses were enlightening.
Participants reported they learned about stroke educational information, how to reach realistic and feasible goals, how to solve and deal with caregiving problems, how to plan for the patient, and how to handle the patients’ needs. Also, they learned how to put a problem into better perspective for a fast and accurate solution. In addition, the participants learned several things about themselves. The program showed them that there were people who cared about them and made them realize that they, as well as the stroke survivor, also were important, which made them feel good. They learned how to not be stressed out and how to solve their own problems. Moreover, the program helped them to be better caregivers.
These types of statements make all the months of grant writing and conducting research worth every second. Telephone interventions do not replace face-to-face contacts with health care professionals. However, they potentially can be used as an adjunct to improve the lives of stroke patients and their families and to meet some of their needs. Thank you, Dr Friedman, for your letter.