Discussion
The findings from this study are consistent with previous
randomized controlled trials of the FSO service.11,12 Dennis et
al12 and Mant et al13 found no significant effects of the service
on patients’ mood. We found effects of intervention on
patients’ knowledge of and satisfaction with hospital and
community services. This is also in line with the results of
Dennis et al,12 who found that patient satisfaction was higher
after intervention from a stroke family care worker.
We did not detect any psychosocial benefits for caregivers
comparable to those reported by Dennis et al12 and Mant et
al.13 However, we did find an effect on knowledge and
satisfaction of knowledge in caregivers, which was consistent
with previous findings,12 suggesting that our FSO acted
primarily as a useful “information provider” and that her
presence increased patients’ and caregivers’ satisfaction with
services. However, this raises the issue of whether increasing
knowledge and satisfaction are justification for health authorities
to purchase the FSO service. In particular, because a
stated aim of the service is to provide emotional support,
there is little evidence that the service improved mood,
although patients and caregivers were more satisfied with
their knowledge of how to obtain emotional support.
Patients and caregivers who received more support from
the FSO may have benefited from receiving the service, but
this effect could have been masked by the results of the whole
sample. For example, the mean number of contacts was 6,
with a very wide range. Therefore, some people had only 1
contact. No statistical analysis was made of the amount of
contact in relation to outcome because neither time nor
number of contacts was considered an accurate reflection of
the amount of work done. The intervention was provided for
only 9 months. For most patients and caregivers, this length
of time was sufficient to achieve the aims of the intervention,
but a few people may have benefited more if the involvement
had been longer. Most of the benefits of the service occurred
during the first 4 months and did not change between 4 and
9 months. Therefore, it seems unlikely that a longer follow-up
would have detected additional benefits of the service.
The inclusion of patients and caregivers who did not want
to receive the FSO service diluted the effects of the intervention.
In particular, the contrast between this evaluation and
that of Mant et al13 suggests that the lack of effect on
caregivers in our own study may have been a result of our
policy of involving the FSO as a member of the multidisciplinary
team. Other members of the multidisciplinary team
may have been more aware of those not allocated to the FSO
and unintentionally compensated by giving those in the
control group increased attention and support. However, it is
not possible to check this possibility formally because no
records were kept of interventions provided to the control
group.