top of page

The Journal of Medical Internet Research

ImpaImpact of a Mobilized Stress Management Program (Pep-Pal) for Caregivers of Oncology Patients: Mixed-Methods Studyct of a Mobilized Stress Management Program (Pep-Pal) for Caregivers of Oncology Patients: Mixed-Methods Study



Caregivers of patients with advanced diseases are known to have high levels of distress, including depression and anxiety. Recent research has focused on recognizing caregivers in need of psychosocial support to help them manage their distress. Evidenced-based technological interventions have the potential to aid caregivers in managing distress.


The objective of our study was to describe caregiver perceptions of the usability and acceptability, and their suggestions for future adaptations, of a mobilized psychoeducation and skills-based intervention.


This study was a part of a larger trial of a mobilized psychoeducation and skills-based intervention (Psychoeducation and Skills-Based Mobilized Intervention [Pep-Pal]) for caregivers of patients with advanced illness. This substudy used a mixed-methods analysis of quantitative data from all 26 intervention participants and qualitative data from 14 intervention caregivers who completed the Pep-Pal intervention. The qualitative semistructured individual interviews, which we conducted within the first 4 weeks after participants completed the intervention, assessed the acceptability and usability of Pep-Pal. Additionally, the qualitative interviews provided contextual evidence of how the intervention was helpful to interviewees in unanticipated ways. We conducted applied thematic analysis via independent review of transcripts to extract salient themes.


Overall, caregivers of patients with advanced cancer deemed Pep-Pal to be acceptable in all Web-based sessions except for Improving Intimacy. Caregivers perceived the program to be of use across the areas they needed and in others that they had not anticipated. Caregiver recommendations of key changes for the program were to include more variety in caregiver actors in sessions, change the title of Improving Intimacy to Improving Relationships, provide an audio-only option in addition to video, and change the format of the mobilized website program to a stand-alone mobile app.


The valuable feedback in key areas from individual interviews will be integrated into the final version of Pep-Pal that will be tested in a fully powered randomized clinical trial.

Trial registration: NCT03002896; (Archived by WebCite at

Keywords: advanced cancer caregivers; bone marrow transplantation; cancer; caregivers; clinical trial, phase I; internet; mHealth; neoplasms; psychoeducation; qualitative research; randomized controlled trial; telemedicine.

©Alaina L Carr, Jacqueline Jones, Susan Mikulich Gilbertson, Mark L Laudenslager, Jean S Kutner, Kristin Kilbourn, Timothy S Sannes, Benjamin W Brewer, Elissa Kolva, Tanisha Joshi, Nicole Amoyal Pensak. Originally published in JMIR Cancer (, 03.05.2019.

Conflict of interest statement

Conflicts of Interest: None declared.

15 views0 comments


bottom of page