Kathrin Milbury

Background: Homebound older adults (≥60 y) and their informal family caregivers face multiple challenges in meeting their instrumental, emotional, and informational needs, which result in lower functional status, multiple comorbidities, and poorer mental health. Caregivers are tasked with providing uncompensated care for medically complex older adults, often without formal health care training. This circumstance may translate to high levels of burden and greater vulnerability to social isolation and loneliness, which may precipitate chronic stress and compromise caregiver health. In recent years, numerous health-focused technologies assisting with health-promoting behaviors such as physical activity, stress management, and nutritional tracking have emerged. However, little is known about how these tools are adopted by family caregivers of homebound older adults. Objective: This descriptive qualitative study aimed to explore how caregivers of homebound older adults perceive technology in the context of supporting caregiving and aging in place through focus groups and one-on-one interviews. Methods: We conducted a descriptive qualitative study using in-person and online video conference focus group methodology with 40 individuals (32 caregivers, 6 clinicians, and 2 additional key informants) to explore perspectives on caregivers’ use of technology to support their caregiving activities. Participants completed a brief sociodemographic questionnaire prior to all interviews. Procedures for thematic analysis were used to analyze the data and identify emerging themes. Results: Three main themes (and related subthemes) emerged from the data: (1) these technologies are not designed for people like us, (2) balancing the scales, and (3) preserving a sense of self. Caregivers’ experiences with technology are marked by a paradox: the same technologies that can ease caregiving activities may also impose new burdens through additional costs, uncertainty, learning demands, and emotional strain. Conclusions: Caregivers should not navigate these technological tensions alone. Realizing the promise of technology requires more than innovative tools—it demands caregiver-centered design, accessible and equitable implementation strategies, and sustained clinical and health system support to ensure that technology alleviates, rather than amplifies, caregiver burden.

Background: We recently completed the efficacy testing of an instructor-led yoga program for patients with thoracic cancer undergoing radiotherapy and their family caregivers. Translating an instructor-led intervention to a mobile app–based delivery model may facilitate the implementation of this yoga program in routine oncological clinical care. Objective: The current study seeks to develop a prototype of the app-based yoga program using a user-centric approach. Methods: Ten patients with a primary diagnosis of lung or esophageal cancer and their family caregivers (N=20) participated in structured interviews. Half of the sample had previously participated in the instructor-led yoga program, whereas half of the sample did not. Participants provided feedback on various mock-ups, wireframes, and yoga videos to guide the development of the app’s content, features, and workflow. Results: All patients (60% male; 70% non–Hispanic White; age: mean 62 years; 90% stage III) and their caregivers (90% female; 50% non–Hispanic White; age: mean 52 years) indicated that developing an app-based program is important and useful. Of the 20 participants, 95% mentioned that having an initial orientation with a yoga interventionist is important, and 90% stated that at least 1 check-in should be available (65% desired weekly check-ins). Participants provided feedback on characteristics of the instructor and instruction preferences. Other desired features included scheduling sessions on a calendar (95%), monitoring progress (95%), receiving practice reminders (90%), providing education on yoga as symptom management (90%), and providing daily inspiration (85%). All participants indicated the importance of including practices of various lengths. Conclusions: Both patients and caregivers deemed an app-based yoga program useful. Regardless of their level of yoga experience, almost all participants desired at least some contact with a live yoga instructor, although the desired frequency varied. These data have informed the development of a prototype that we are currently field-testing to ensure feasibility and acceptability.

Background and ObjectivesTumor-related aphasia (TRA) affects approximately 24% of patients with brain tumors and significantly influences quality of life; yet, few studies have examined TRA across ...

PURPOSE: Patients with advanced thoracic cancers undergoing standard radiotherapy (RT) have a high risk of experiencing performance declines and poor quality of life (QOL). Exercise programs may improve objective and subjective performance; yet, adherence remains poor. Including family caregivers as active intervention, participants may improve adherence and thus efficacy. Thus, this clinical trial seeks to examine the efficacy of a patient-caregiver dyadic yoga intervention relative to a dose-matched education/support (ES) intervention. MATERIALS AND METHODS: Patients with lung or esophageal cancer undergoing at least 5 weeks of RT and their family caregivers were randomly assigned to either a 15-session yoga or ES comparison intervention. Patients and caregivers were assessed at baseline (T1), the last day of RT (T2) and 1 (T3), 2 (T4), and 3 (T5) months later. Patients completed the 6-minute walk test (6MWT; primary outcome) and both patients and caregivers completed a validated QOL measure (secondary outcomes). RESULTS: A total of 222 participants were randomly assigned. For the 6MWT, patients in the yoga group performed significantly better than those in the ES group across T2-T5 (least squared means [LSMs] in meters: yoga = 469 v ES = 441, P = .03). Patients in the yoga group also reported improved physical (LSMs: yoga = 44.7 v ES = 41.6, P = .03) but not mental QOL scores across T2-T5 compared with those in the ES group. As exploratory outcomes, patients in the yoga group also reported improved sleep ( P = .01) and coping efficacy ( P = .02). CONCLUSION: Yoga significantly improves functional capacity and subjective physical QOL in patients undergoing thoracic RT. Involving a family caregiver may improve intervention adherence.

Background: Survivors of young adult (YA) cancer often experience substantial stress during the transition to survivorship, which may impair sleep. Although the stress–sleep link is well established, its role within survivor–spouse dyads remains unclear. Emotional intimacy may influence how couples regulate stress and affect sleep. This study examined dyadic associations between stress and sleep among survivors of YA cancer and their spouses and significant others (hereafter spouses) and tested emotional intimacy as a moderator. Methods: A total of 103 survivor of YA cancer–spouse dyads completed self‐reported measures of stress, emotional intimacy, and sleep quality. An actor‐partner interdependence moderation model was used to test how each person's stress was related to their own and their spouse's sleep quality and the moderating role of emotional intimacy. Results: In our model, higher stress was associated with poorer sleep quality among both survivors ( β = 0.405, p < 0.001) and spouses ( β = 0.172, p = 0.041), indicating significant actor effects, whereas no partner effects from stress were observed. Emotional intimacy moderated the stress‐sleep association among survivors ( β = −0.224, p = 0.004), but not among spouses ( β = −0.012, p = 0.892). Conclusions: Stress emerged as a key intrapersonal determinant of sleep quality for both survivors of young adult cancer and their spouses, indicating that stress management may benefit sleep in both groups. Emotional intimacy buffered stress‐related sleep disruption among survivors, but not spouses, highlighting role‐specific mechanisms. Tailored approaches may improve sleep and quality of life.

BACKGROUND We recently completed the efficacy testing of an instructor-led yoga program for patients with thoracic cancer undergoing radiotherapy and their family caregivers. Translating an instructor-led intervention to a mobile app–based delivery model may facilitate the implementation of this yoga program in routine oncological clinical care. OBJECTIVE The current study seeks to develop a prototype of the app-based yoga program using a user-centric approach. METHODS Ten patients with a primary diagnosis of lung or esophageal cancer and their family caregivers (N=20) participated in structured interviews. Half of the sample had previously participated in the instructor-led yoga program, whereas half of the sample did not. Participants provided feedback on various mock-ups, wireframes, and yoga videos to guide the development of the app’s content, features, and workflow. RESULTS All patients (60% male; 70% non–Hispanic White; age: mean 62 years; 90% stage III) and their caregivers (90% female; 50% non–Hispanic White; age: mean 52 years) indicated that developing an app-based program is important and useful. Of the 20 participants, 95% mentioned that having an initial orientation with a yoga interventionist is important, and 90% stated that at least 1 check-in should be available (65% desired weekly check-ins). Participants provided feedback on characteristics of the instructor and instruction preferences. Other desired features included scheduling sessions on a calendar (95%), monitoring progress (95%), receiving practice reminders (90%), providing education on yoga as symptom management (90%), and providing daily inspiration (85%). All participants indicated the importance of including practices of various lengths. CONCLUSIONS Both patients and caregivers deemed an app-based yoga program useful. Regardless of their level of yoga experience, almost all participants desired at least some contact with a live yoga instructor, although the desired frequency varied. These data have informed the development of a prototype that we are currently field-testing to ensure feasibility and acceptability. CLINICALTRIAL

Objective: Lymphomas are one of the primary cancers that affect adolescents and young adults (AYAs). We examined the feasibility of two group‐based interventions—one meditation‐based and one education‐based—for AYAs with lymphoma. We also explored their potential benefits for reducing psychological distress and cancer‐related symptom burden. Methods: Patients aged 18–39 years with lymphoma undergoing chemotherapy were randomized to either the meditation or psychoeducation intervention. Both received 5 weekly sessions (60 min each) delivered in a group setting via videoconferencing. Participants were assessed at baseline (T1), 6 weeks (T2), and 12 weeks (T3). Results: Participants were randomized to the meditation ( n = 28) or psychoeducation intervention ( n = 32) with a consent rate of 51.4%. Session attendance was similar across interventions, with 60.7% in the meditation intervention and 56.3% in the psychoeducation intervention attending all 5 sessions (χ ² (4) = 0.65). Assessment completion rates in the meditation intervention were 75% at T2 and 64% at T3; in the psychoeducation intervention, rates were 78% at both time points. From T1 to T3, the psychoeducation intervention showed significant improvements in cancer‐related symptom severity (mean difference = 0.75, p = 0.041) and interference (mean difference = 1.07, p = 0.028). Conclusions: Videoconference‐delivered, group‐based supportive care for AYAs with lymphoma during active cancer treatment appears feasible and may help reduce symptom burden or prevent further worsening of quality of life. Virtual delivery enhances accessibility and scalability across diverse clinical settings. Strategies to improve adherence and retention are needed to optimize engagement in this population. Clinical trial registration: ClinicalTrials.gov Identifier NCT04270266.

Background: Parents with advanced cancer and their partners are more likely to experience psychological distress than their counterparts without minor children. Greater relationship functioning may support parents in distress.Aims: The current study seeks to explore couples' cancer‐related parenting communication behaviors, perception and their associations with psychological and relational wellbeing.Methods: Women diagnosed with an advanced breast cancer (Stage III‐IV) and their partners (n = 46 dyads) parenting a minor child reported psychological symptoms (CES‐D, GAD‐7), relational wellbeing (DAS‐7) and cancer‐related parenting concerns (PCQ, patient only). As part of an observational task, couples completed a Family Concern Inventory (FCI) to identify cancer‐related family concerns. Then, each member selected one concern to discuss. Immediately after the discussion, participants rated their perception of the discussion and their state positive and negative affect.Results: Parents (mean age = 43.4 years, 56% non‐Hispanic White, two female couples) endorsed high psychological distress, with patients reporting greater family concerns than partners (t = 3.80, p < 0.001). Both members of the couple indicated high levels of self‐disclosure and felt validated and accepted by their partners during the discussion. Yet, patients rated the discussion as more helpful than partners (t = 2.3, p = 0.03). There was a small reduction in positive affect following discussion for partners only. However, the more partners disclosed their emotions, the greater their post‐discussion positive affect (r = 0.50, p < 0.001).Conclusions: Couples' ability to openly communicate around cancer‐related parenting concerns is associated with aspects of psychological adjustment. Findings identify targets and underscore importance of flexibility for future interventions.

Introduction: Patients with advanced cancer and their spousal caregivers who parent minor children report unmet parenting concerns and increased psychological distress. Seeking to address these important supportive care needs, this RCT examined the feasibility, acceptability, and initial evidence for the efficacy of a novel psychosocial intervention. Patients and Methods: Patients with a metastatic solid malignancy and their spouses completed self-reported validated assessments of psychological symptoms and cancer-related parenting outcomes and were then randomized to the parent support intervention or a usual care (UC) group. Both groups were reassessed 6 and 12 weeks later. Dyads randomized to the counselor-led intervention attended the first 2 sessions jointly addressing illness communication and family routines. Spouses individually attended the last 2 sessions focusing on caregiver support and family death preparedness. Results: Fifty patients and their spouses were randomized. All a priori feasibility benchmarks were met. Attendance in the intervention arm was high with 84% of caregivers attending all 4 sessions (mean = 3.48). The program was evaluated favorably by all patients and spouses deeming the intervention as beneficial. Caregivers rated the individual-level sessions as particularly helpful. Multilevel analyses revealed a significant reduction in anxiety symptoms (P = .05) and improvement in parenting efficacy (P = .03) at 6-week follow-up in the intervention group compared with UC. Conclusions: The initial testing of our parent support intervention yielded promising results regarding feasibility and preliminary evidence for efficacy for reduced anxiety symptoms and improved parenting efficacy. This program may meet a frequent and distressing psychosocial need that is typically unaddressed by multidisciplinary oncology teams.