Technology-enhanced Transitional Palliative Care for Family Caregivers in Rural Settings

为农村环境中的家庭护理人员提供技术增强的过渡性姑息治疗

• 批准号: 10166953
• 负责人: JOAN M. GRIFFIN
• 金额: $ 59.82万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-19 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10166953
• 关键词: Address; Ambulatory Care; Attention; Cancer Burden; Caregiver Burden; Caregiver support; Caregivers; Caring; Clinical Trials; Clinical Trials Design; Communication; Continuity of Patient Care; Coping Skills; Cost Measures; Data; Emergency department visit; Employment; Enhancement Technology; Enrollment; Face; Family; Family Caregiver; Goals; Health; Health Care Costs; Health system; Healthcare; Healthcare Systems; Home; Hospitalization; Hospitals; Individual; Intervention; Knowledge; Life; Link; Measures; Medically Underserved Area; Mental Depression; Methods; Modeling; National Institute of Nursing Research; Nurses; Outcome; Palliative Care; Patient Care; Patients; Persons; Physicians; Pilot Projects; Plant Roots; Provider; Public Health; Quality of life; Randomized; Randomized Controlled Clinical Trials; Readiness; Reporting; Research; Role; Rural; Science; Services; Strategic Planning; Technology; Testing; Time; United States; adverse event risk; base; care costs; care recipients; care systems; caregiving; caregiving outcomes; control trial; coping; cost; design; effective intervention; efficacy testing; evidence base; experience; family burden; family support; group intervention; health information technology; improved; innovation; loved ones; medically underserved; meetings; novel; novel strategies; patient home care; prospective; psychologic; rapid growth; response; rural area; rural setting; satisfaction; service delivery; skills; synergism; theories; treatment as usual; underserved rural area; urban setting; usual care arm; video visit; virtual visit

PROJECT SUMMARY The proposed study expands the body of knowledge regarding methods to address the needs of family care- givers (FCGs) transitioning from hospital-based palliative care to homes in rural, medically-underserved areas. Caregiving for individuals with life-limiting illnesses frequently causes caregiver burden, depression, decreased coping skills and quality of life. Often, FCGs are confronted by challenges such as inadequate caregiving knowledge and skills, limited support, demanding family circumstances, and limited time for themselves. Alt- hough FCGs often have substantial personal health needs equal to or greater than the patients' needs, the FCGs' needs have received limited attention. It is, therefore, critically important that interventions be explored that link proven strategies in an approach to implementing transitional palliative care (TPC) in a way that in- creases communication and support to FCGs. The purpose of this study is to evaluate a novel, nurse-led, technology-enhanced, theory-based care model of transitional palliative care (TPC) for FCGs living in rural, medically underserved areas. A randomized controlled clinical trial design will be used to address the following specific aims: (1) Evaluate the effect of technology- enhanced TPC for FCGs on caregiving preparedness (Preparedness for Caregiving Scale), communication with clinicians (Communication with Physicians Scale), and satisfaction with care (PACIC); (2) Evaluate the effect of technology-enhanced TPC for FCGs' quality of life (Caregiver Quality of Life Scale-Cancer), burden (Bakas Caregiving Outcomes Scale-Revised), coping skills (Post-Discharge Coping Difficulty Scale), and de- pression (CESD-10); and (3) Examine the effect of technology-enhanced TPC for FCGs on healthcare costs. An intensive 8 week transitional care intervention, TPC for FCGs focuses on the needs of FCGs of palliative care patients. In this study, 240 FCGs will be randomized to either the experimental or usual care control groups. The intervention includes in-hospital and in-home components. Because the FCGs and care recipients live in rural settings, the in-home component will be conducted using virtual visits. Outcomes will be evaluated at 2 weeks and 8 weeks from baseline (Aims 1 & 2) using a response-feature analysis as our primary approach to analyzing these repeated measures data. Both descriptive and multivariable-adjusted measures of costs for 6 months post-enrollment from a societal perspective will be analyzed (Aim 3). This study, is: (1) aligned with NINR's strategic goal to develop and test strategies to minimize the physical and psychological burdens on FCGs' health, particularly as the care recipients near the end of their life; (2) innova- tive because it represents a substantive departure from current transitional care approaches that are limited to in-person interactions in both the hospital and home; and (3) significant because it addresses the rapidly in- creasing need for TPC services to medically underserved rural areas.

项目概要 拟议的研究扩展了有关解决家庭护理需求的方法的知识体系- 给予者（FCG）从医院的姑息治疗过渡到医疗服务不足的农村地区的家庭。 照顾患有限制生命的疾病的人经常会导致照顾者负担、抑郁、减少 应对技巧和生活质量。 FCG 通常面临护理不足等挑战 知识和技能、有限的支持、苛刻的家庭环境以及有限的个人时间。替代- 尽管 FCG 的个人健康需求通常等于或大于患者的需求，但 FCG 的需求受到的关注有限。因此，探索干预措施至关重要 将经过验证的策略与实施过渡性姑息治疗（TPC）的方法联系起来，其方式是： 加强与 FCG 的沟通和支持。 本研究的目的是评估一种新颖的、护士主导的、技术增强的、基于理论的护理模式 为生活在农村、医疗服务匮乏地区的 FCG 提供过渡性姑息治疗 (TPC)。随机对照 临床试验设计将用于实现以下具体目标：（1）评估技术的效果- 增强 FCG 在护理准备（护理准备量表）、沟通方面的 TPC 与临床医生的沟通（与医生沟通量表）和护理满意度（PACIC）； (2) 评估 技术增强的 TPC 对 FCG 生活质量（看护者生活质量量表-癌症）的影响、负担 （巴卡斯护理结果量表 - 修订版）、应对技能（出院后应对困难量表）和 de- 压力（CESD-10）； (3) 检查 FCG 的技术增强型 TPC 对医疗保健成本的影响。 TPC for FCG 是一项为期 8 周的强化过渡护理干预，重点关注 FCG 姑息治疗的需求 照顾病人。在这项研究中，240 个 FCG 将被随机分配到实验对照组或常规护理对照组 组。干预措施包括医院内和家庭内的部分。因为 FCG 和护理对象 生活在农村地区，家庭部分将通过虚拟访问进行。将评估结果 在距基线 2 周和 8 周（目标 1 和 2）时，使用响应特征分析作为我们的主要方法 分析这些重复测量的数据。描述性成本测量和多变量调整成本测量 将从社会角度分析入学后 6 个月的情况（目标 3）。 这项研究是：(1) 与 NINR 的战略目标一致，即制定和测试策略，以最大限度地减少物理和 FCG 健康的心理负担，特别是当护理对象接近生命尽头时； (2) 创新- 之所以如此，是因为它代表着与目前仅限于 在医院和家里进行面对面的互动； (3) 意义重大，因为它解决了快速发展的问题 医疗服务不足的农村地区对 TPC 服务的需求不断增加。

项目成果

Death and Grieving for Family Caregivers of Loved Ones With Life-Limiting Illnesses in the Era of COVID-19: Considerations for Case Managers.

• DOI: 10.1097/ncm.0000000000000485
• 发表时间: 2021-03-01
• 期刊: Professional case management
• 影响因子: 1.5
• 作者: Holland DE;Vanderboom CE;Dose AM;Moore D;Robinson KV;Wild E;Stiles C;Ingram C;Mandrekar J;Borah B;Taylor E;Griffin JM
• 通讯作者: Griffin JM

A technology-enhanced model of care for transitional palliative care versus attention control for adult family caregivers in rural or medically underserved areas: study protocol for a randomized controlled trial.

• DOI: 10.1186/s13063-020-04806-0
• 发表时间: 2020-10-28
• 期刊: Trials
• 影响因子: 2.5
• 作者: Holland DE;Vanderboom CE;Mandrekar J;Borah BJ;Dose AM;Ingram CJ;Griffin JM
• 通讯作者: Griffin JM

A Methodological Approach for Documenting Multi-Component Interventions Targeting Family Caregivers.

• DOI: 10.1177/07334648221137882
• 发表时间: 2023-03
• 期刊: JOURNAL OF APPLIED GERONTOLOGY
• 影响因子: 3
• 作者: Griffin, Joan M.;Vanderboom, Catherine E.;Gustavson, Allison M.;Kaufman, Brystana G.;Ingram, Cory;Wild, Ellen;Dose, Ann Marie;Mandrekar, Jay;Holland, Diane E.
• 通讯作者: Holland, Diane E.

Improving Transitions in Care for Patients and Family Caregivers Living in Rural and Underserved Areas: The Caregiver Advise, Record, Enable (CARE) Act.

• DOI: 10.1080/08959420.2022.2029272
• 发表时间: 2024-07-03
• 期刊: JOURNAL OF AGING & SOCIAL POLICY
• 影响因子: 5.1
• 作者: Griffin, Joan M.;Kaufman, Brystana G.;Bangerter, Lauren;Holland, Diane E.;Vanderboom, Catherine E.;Ingram, Cory;Wild, Ellen M.;Dose, Ann Marie;Stiles, Carole;Thompson, Virginia H.
• 通讯作者: Thompson, Virginia H.