Psychiatric Disorder in Dying Patients & Their Survivors

临终患者的精神疾病

• 批准号: 6644135
• 负责人: Holly Gwen Prigerson
• 金额: $ 51.57万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-08-07 至 2006-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6644135
• 关键词: adult human (21+); behavioral /social science research tag; bereavement; caregivers; clinical depression; clinical research; death; grief; human mortality; human subject; interview; longitudinal human study; neoplasm /cancer; suicide; terminal patient care

DESCRIPTION (provided by applicant): Little is known about the prevalence and treatment of psychiatric disorders among terminally ill cancer patients and their caregivers, nor about the ways in which mental health may affect the patient's comfort at death, and the impact this may have on the caregiver' s bereavement adjustment. A sample of cancer patients (N=300) with a life-expectancy of < 6 months, and their primary caregivers (eg, spouses, adult children; N=3 00), will be recruited from cancer clinics at Yale, the Veterans Affairs Connecticut Healthcare System, and Memorial Sloan-Kettering. A structured diagnostic interview will be used to evaluate psychiatric status of patients and caregivers. Newly refined and validated instruments will determine "caseness" of Complicated Grief and provide a thorough evaluation of suicidality of patients and caregivers. Interviews will occur at 2 time points: (1) at baseline when patients are terminally ill and caregivers are attending to them; (2) at follow-up for caregivers 6 months after the patients' death. The study aims are to determine: (1) the prevalence of psychiatric disorders and their treatment among terminally ill cancer patients and their primary caregivers, and (2) the influence of the patients' mental health on their degree of comfort at the time of death (eg, lack of pain, physical, emotional, social, existential distress). The study also aims to determine the extent to which the bereaved caregiver's mental health at follow-up is influenced by: a.) the caregiver's baseline mental health and mental health service use, b.) realistic caregiver expectations of the patient's life expectancy, c.) patient comfort, and d.) caregiver satisfaction about the way the death occurred (eg, absence of regrets about the care provided, having an opportunity to say "good-bye"). By determining the prevalence of specific psychiatric disorders and their treatment in terminally ill cancer patients and their caregivers, clinicians will be alerted to likely mental disorders for which to screen, refer, and/or treat. If patient's with better mental health are more likely to die comfortably, then interventions to improve patient mental health would be expected to improve the patient's quality of life at the time of death. If caregiver's better mental health at follow-up is significantly influenced by their baseline mental health, their realistic expectations of the patient's life-expectancy, and their satisfaction with the way the death occurred, each of these factors could be targeted by future interventions designed to improve the mental health of bereaved survivors.

描述（由申请人提供）：对于绝症癌症患者及其护理人员精神疾病的患病率和治疗知之甚少，也不了解心理健康可能影响患者临终舒适度的方式，以及这可能对他们的生活产生的影响。照顾者的丧亲调整。将从耶鲁大学的癌症诊所、退伍军人事务部招募预期寿命 < 6 个月的癌症患者 (N=300) 及其主要照顾者（例如配偶、成年子女；N=3 00）样本康涅狄格州医疗保健系统和纪念斯隆-凯特琳。将使用结构化诊断访谈来评估患者和护理人员的精神状况。新改进和验证的仪器将确定复杂悲伤的“案例”，并对患者和护理人员的自杀倾向进行全面评估。访谈将在两个时间点进行：(1) 基线时，患者病入膏肓且护理人员正在照顾他们； (2) 患者死亡后6个月对照顾者进行随访。该研究的目的是确定：（1）晚期癌症患者及其主要照顾者中精神疾病的患病率及其治疗，以及（2）患者的心理健康对其死亡时的舒适程度的影响（例如，没有疼痛、身体、情感、社交、存在的痛苦）。该研究还旨在确定失去亲人的照顾者在随访时的心理健康受以下因素影响的程度：a.）照顾者的基线心理健康和心理健康服务的使用，b.）照顾者对患者预期寿命的现实期望，c） .) 患者舒适度，以及 d.) 护理人员对死亡发生方式的满意度（例如，对所提供的护理没有遗憾，有机会说“再见”）。通过确定晚期癌症患者及其护理人员中特定精神疾病的患病率及其治疗方法，临床医生将警惕可能需要筛查、转诊和/或治疗的精神疾病。如果心理健康状况较好的患者更有可能安逸地死去，那么改善患者心理健康的干预措施有望改善患者死亡时的生活质量。如果护理人员在随访时更好的心理健康状况受到他们的基线心理健康状况、他们对患者预期寿命的实际期望以及他们对死亡发生方式的满意度的显着影响，那么未来的干预措施可以针对这些因素中的每一个因素，设计出以下干预措施：改善失去亲人的幸存者的心理健康。