DISCUSSION
death, UC, glioma, early‐stage disease, cognitive deficits
DISEASE, DISEASE PROGRESSION, GLIOMA, PRIMARY BRAIN TUMORS
The goal of this pilot randomized controlled trial was to assess the feasibility and preliminary efficacy of a yoga intervention for caregivers of glioma patients undergoing radiotherapy that was delivered to either patient‐caregiver dyads or caregivers individually. Our results revealed that the intervention is feasible, as our a priori criteria regarding consent, retention, and attendance were met in both the CY and DY groups. Although the DY group had a higher numeric attendance rate, both the DY and CY groups reached the a priori attendance rate benchmark of 67%. It appears that delivering the interventions concurrently to patients’ radiation treatment plan facilitates session attendance regardless of modality (i.e., in‐person at the hospital or via videoconference). The overall 3‐month follow‐up retention rate was relatively low (62%), and attrition was mainly due to patients’ high symptom burden, disease progression, and death—a challenge that is frequently encountered in studies that include caregivers of patients whose expected survival time is short. Moreover, with the onset of the COVID‐19 pandemic, caregivers’ access to the hospital was restricted, and participants received follow‐up care from their medical team mainly via telemedicine. Thus, attrition may have also been a result of less frequent clinic visits.We were particularly interested in determining whether caregivers favor and benefit dyadic or individual delivery of the intervention. Although dyadic delivery as a care model has increasingly gained attention in psycho‐oncology and supportive care, our results revealed that caregivers in the CY arm found the intervention significantly more useful and beneficial than those in the DY arm. These quantitative results are supported by the qualitative accounts highlighting that caregivers in the CY arm enjoyed practicing self‐care and having time to relax and escape their caregiving role. Although caregivers in the DY arm mentioned benefits to the patient and benefits to their relationship with the patient, they did not mention the benefits of respite and relaxation. The dyadic setting may not allow caregivers to fully relax and focus on themselves as they remain aware of the needs of the patient. This finding may be particularly true for those caring for patients with cognitive deficits. Lastly, although the transition to videoconference delivery with the onset of the pandemic did not impact attendance, our effect size results indicate that caregivers favored in‐person delivery. However, caregivers also acknowledged the benefits of remote delivery in the qualitative interviews.Our findings also suggest that, even with the lower attendance rate of the CY group, the CY intervention revealed stronger evidence for preliminary efficacy than the DY intervention in terms of improved mental QOL and caregiver reactions. Although the trial was not adequately powered to definitively assess efficacy, our hypotheses were supported by the medium effect sizes for improved mental QOL and financial burden, the latter of which could be driven by the larger proportion (albeit not statistically significant) of caregivers in the CY group who were employed full‐time. As such, group differences regarding financial burden need to be interpreted with caution particularly as the intervention did not target financial distress. Yet, as the subscale assessing financial burden measures Moreover, we would like to note that there was not only a lack of evidence regarding the benefits for the DY group relative to the UC group, caregivers in the DY group also reported Our findings generally agree with those of the few previous studies in this population. For instance, a Dutch study found that a 6‐session, psychologist‐led cognitive behavioral therapy intervention had a small effect on mental QOL.Given the findings of the present study, further investigation of the CY intervention is warranted. Our findings suggest that, for caregivers of patients with primary brain tumors, a caregiver‐focused supportive care delivery is preferable to dyadic approaches. However, further study that includes the direct comparisons of dyadic and individual delivery is needed along with models that more precisely establish settings in which a dyadic, individual or a combination of dyadic and individual components as in a “hybrid” (or even group‐based) format is advantageous should be developed. For instance, caregivers of patients who have early‐stage disease and/or less disease burden may respond to dyadic interventions, whereas those facing a high caregiving load may benefit from individual interventions.The findings of the present study should be interpreted with caution. The objective of this trial was to examine the feasibility and In summary, the findings of the present study suggest that, although both the CY and DY interventions are feasible, the CY intervention is subjectively more beneficial to caregivers of glioma patients. This study also revealed that the use of a videoconferencing platform (Zoom in this case) is an acceptable approach for the delivery of interventions to caregivers of glioma patients. Finally, the findings of this trial suggest that relative to the DY intervention and UC, the CY intervention has greater preliminary efficacy in terms of improving mental health aspects of QOL as well as caregiving‐related esteem, health decline, and financial burden. An adequately powered efficacy trial of the CY intervention with an attention control group is warranted.