1. G. Warner, S. Hutchinson, R. Genoe and N. Geddes,

2. Special thanks to…. Robin Parker from Kellogg Library for assistance in conducting the database searches Funded by… Nova Scotia Health Research Foundation through a REDI team development grant

3. What is known from the existing literature about the delivery and effectiveness of self-management interventions for family caregivers of older adults?

4. What self-management components were included in the identified programs? What did these programs look like? (e.g. participants, duration, group versus individual) How effective were the programs? What types of self- management programs are feasible?

5. Self-management programs teach individuals not only to medically manage their condition, but also to manage the psychological, social and lifestyle dimensions associated with living with the condition. (Barlow, 2002) What is self-management for unpaid caregivers who care for a spouse/parent or friend with a debilitating condition.

6. Where is the unpaid caregiver?

7. 1.Action planning, goal setting & follow-up 2.Caregiver self care & stress reduction 3.Decision support tools 4.Group education, coaching session 5.Individual education, coaching session 6.Information via computer or 7.telephone or 8. video/audio or 9. written 10.Peer group support 11.Problem solving

8. Must be an intervention Must include family caregivers, either alone or as a caregiver /care receiver dyad Participant caring for someone with an ongoing condition (or limitations due to aging) Intervention described as a self-management/self- care/patient education /empowerment program

9. Study published prior to the year 2000 Intervention only delivered psychotherapy or exercise Delivered primarily as inpatient/resident program Care recipients 55

10. Databases Searched: Central, Cinahl, Medline, Embase, Cochrane from 2000 to 2012 Located 2227 sources 2 stages: Two individuals reviewed 1) abstracts then 2) full manuscripts Conflicts discussed and consensus decision Extracted information using NVivo and Excel 32 studies met inclusion criteria

11. Number of Abstracts reviewed =2227 Included/Reviewed= 130 Excluded= 2097 Included after manuscript review= 42 After cross referencing by study = 32 Excluded after manuscript review= 88 Reasons: Study Design= 31 Participants= 31 Intervention= 21 Language= 5

12. Of the 32 studies examined: Study Design: RCTs = 18 Participants: Caregiver only = 17 Dyads = 15 Delivery format: Individual/dyad = 17 Group = 9 Combination = 6

13. 29 out of the 32 interventions were disease specific Conditions: Alz Dis/Dementia = 17 Stroke = 5 Osteoarthritis = 2 Heart failure=2 Cancer = 2 Parkinsons Disease=1

14. 1.Won Won, 2008:Powerful tools for caregiving (PTC) 2.Ducharme, 2011:Learning to be a caregiver 3.van den Heuvel,2000: Group and individual support program for caregivers of stroke patients 4.Johnston, 2007: Workbook intervention for stroke patients and carers 5.Gitlin, 2010: Advancing Caregiver Training (ACT) 6.Glueckauf, 2007: Telephone-based cognitive-behavioral intervention

15. Self-management programs are most commonly provided to only the caregiver who is caring for someone with dementia There are some care partner/dyad interventions for persons with stroke or chronic heart failure that look interesting The sample size for some of the studies was too small to see if the intervention is effective, many were pilots of planned RCTs

16. All 32 interventions had an education/ coaching component Other components included were: Information delivered (written, telephone, computer or video) = 28 Addressed caregiver self-care or stress reduction = 28 Involved problem solving = 25 Had action planning or goal setting with follow-up = 18 Included a peer group support = 9

17. Not possible to conduct a meta-analysis because of clinical heterogeneity: Diverse conditions 161 outcome measures used, of these 42 were developed for the study only ~50% had an RCT design

18. 1) Grouped individual outcome measures by general categories, three most prevalent categories were Psycho-social Self-care Physical health/fitness 2) Ranked results by: Statistically significant difference Positive results but not statically significant No effect

19. The number of studies with statistically results was not substantially difference by : Delivery method – (in-person, telephone, computer) Format – (group, individual, both) Location – (home, community) Duration of intervention – ( 21 weeks) Number of sessions – ( 20) Number of self management components (range 3 – 10)

20. Pros: If in home, convenient for caregivers Better for communication Cons: Time consuming for staff High cost to provider If in community not convenient for caregivers In-person = 9 Pros: Less disruption to care duties Low cost to caregivers and providers Easy to organise and participate in Can reach rural populations Cons: Can hinder communication Requires equipment and a connection Telephone = 6 Computer = 3 Pros: More flexible for individually tailoring the intervention Allows participants opportunity to meet facilitator but convenience of telephone access Cost effective Cons: None reported In-person + telephone = 13

21. Self management programs had two common objectives; teach caregivers self-care or self- management principles and; provide information or education tailored to caregiver concerns, usually related to the care recipients health condition Self-management programs are diverse – conditions, change they hope to effect in the participant, sometimes in conjunction with exercise, outcomes What is feasible? one-to-one in person can be high resources outside the home may be hard for caregivers to access Telephone is cost efficient but may not be acceptable for caregivers Combo of phone/in person may work the best