McMillan, S.C., Small, B.J., Weitzner, M., Schonwetter, R., Tittle, M., Moody, L., . . . Haley, W.E. (2006). Impact of coping skills intervention with family caregivers of hospice patients with cancer: A randomized clinical trial. Cancer, 106(1), 214–222.

The COPE method involves the following four interventions.

• Creativity (viewing problems from different perspectives to develop new strategies for solving caregiving problems)
• Optimism (having a positive but realistic attitude toward the problem-solving process)
• Planning (setting reasonable caregiving goals and thinking out, in advance, the steps necessary to reach those goals)
• Expert information (what nonprofessionals need to know about the nature of a problem and when to get professional help and what family caregivers can do on their own to deal with the problem)

The COPE intervention was delivered by nurses, and a home health aide was present for each visit to provide respite so that caregivers could focus on the intervention. No specific data were given on length of intervention, although it was inferred to occur over two weeks. The study was divided into three arms.

• Group 1 was hospice standard care only (n = 109).
• Group 2 was hospice standard care plus supportive visits from the intervention nurse and home health aide made on the same schedule as the COPE intervention group (same amount of time per session as group 3, nurse provided individual support and discussed feelings) (n = 108).
• Group 3 was hospice standard care plus intervention visits by a nurse who taught them the problem-solving method (n = 111).
   

• The sample (N = 328) included adults with cancer in a hospice program and their caregivers (caregivers identified by hospice without having cancer themselves).
• Patients had at least a sixth-grade education and were cognitively intact.

• Home

A properly designed randomized, controlled trial with three arms was used.

• Caregiver demands scale (to measure burden)
• Caregiver Quality-of-Life Index–Cancer Memorial Symptom Assessment Scale (measures burden of cancer symptoms)
• Caregiver mastery
• Brief COPE scale (to measure use of problem-focused versus emotion-focused coping strategies)

Significant group by time interactions were found between the standard group and the COPE group (group 3) in quality of life, symptom burden, and caregiving task burden. No significant differences were found between the standard group and the support condition (group 2) in quality of life, symptom burden, or caregiving task burden. The COPE group had significant improvements in symptom burden over time, whereas the usual care group did not. Mastery and coping skills were not significantly different among groups.

Although substantial attrition occurred across all three groups longitudinally, researchers examined for differences. The only significance found was that completers were initially older than noncompleters. No effects of attrition by group were significant.

• No specific information was given regarding how many intervention sessions were delivered, what happened at each session, or what the total length of the intervention was (although it is inferred to be within two weeks).