Symptom Care by Phone for Hospice Caregiver Support and Cancer Symptom Relief

通过电话进行症状护理，为临终关怀护理人员提供支持和癌症症状缓解

基本信息

批准号：
7887034
负责人：
KATHLEEN H MOONEY
金额：
$ 83.86万
依托单位：
UNIVERSITY OF UTAH
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-01 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7887034
关键词：
Accounting Address Adherence Adult Affect Age-Years Anxiety Bereavement Cancer Patient Caregiver Burden Caregivers Caring Case Manager Clinical Clinical Trials Communication Computers Confusion Constipation Data Depressed mood Desire for food Development Diagnostic Neoplasm Staging Distress Dyspnea Elements Emotional Family Family Caregiver Family member Fatigue Grief reaction Growth Health Personnel Home environment Home visitation Hospice Care Hospice Programs Hour House Call Individual Information Technology Instruction Intervention Knowledge Lead Left Life Link Malignant Neoplasms Mediating Mental Depression Methods Modeling Monitor Nausea Nurses Outcome Outcomes Research Pain Palliative Care Palliative Care Nursing Participant Patient Care Patient Monitoring Patients Pattern Process Program Research Project Grants Provider Public Health Quality of life Randomized Randomized Clinical Trials Recommendation Reporting Research Research Project Grants Role Sampling Self Efficacy Severities Sleep Spouses Structural Models Suggestion Support System Supportive care Symptoms System Telecommunications Telephone Testing Time Update Xerostomia arm base comparison group coping design end of life end of life care experience falls group intervention hospice environment improved patient home care physical conditioning pressure programs prospective restoration satisfaction skills symptom management treatment as usual

项目摘要

Individuals dying from cancer often live out their lives at home with a host of poorly controlletd symptoms. Ineffective symptom management results, in part, from inadequate monitoring of patients once they leave the treatment-focused arena of the clinical setting. The changing pattern of symptoms is challenging as care strategies and recommendations from previous encounters with healthcare providers become quickly outdated. The burden of end-of-life care largely falls to family caregivers, usually a spouse or partner, who feel enormous pressure to provide physical and supportive care but often lacks the knowledge and skill resulting in significant caregiver burden and distress that may extend into bereavement. This prospective, clinical trial proposes to test a telecommunication system. Symptom Care by Phone- Hospice that has been designed to bridge the divide between home and palliative care support for patients at the end of life and their family caregiver. SCP-Hospice has three elements: 1) daily monitoring of 12 symptoms common at entj of life, 2) automated alerting of the hospice RN case manager about symptoms that have exceeded a pre-set threshold for symptom severity or distress, and 3) automated, just in time, tailored care management strategies for the caregiver to implement to address the patient's symptoms. Caregivers call the SCP-Hospice system daily to report patient symptoms and then are immediately provided automated, tailored care suggestions paired to the specific symptom profile. The sample will consist of 300 spouse/partner caregivers of cancer patients, 50+ years of age newly admitted to a home hospice program and their hospice RN case manager. Caregiver participants will be randomized to the SCP-Hospice intervention or to usual hospice care. The specific aims of the study are to test whether the SCP-Hospice intervention reduces severity and distress from 12 different symptoms and whether it decreases caregiver burden, anxiety, depressed mood and distress about the patient's symptoms and improves caregiver sleep when compared with usual care. The mechanisms that explain how SCP-Hospice affect these outcomes also will be explored. Other aims will compare patient care strategies utilized by caregivers and evaluate caregiver and Hospice RN satisfaction with the SCP system. In addition, utilizing data from the other two research projects in this program project, two synergistic aims will examine the impact of the SCP intervention on the quality of hospice RN-caregiver communication about unrelieved symptoms and determine whether caregivers utilizing SCP-Hospice experience less depression and improved adjustment during bereavement in comparison to usual care.

死于癌症的人常常在家中度过余生，并出现一系列难以控制的症状。无效的症状管理部分是由于患者离开医院后对其监测不充分造成的。以治疗为重点的临床环境。症状的变化模式对于护理来说具有挑战性以前与医疗保健提供者接触的策略和建议很快就会变得过时的。临终关怀的负担主要落在家庭照顾者身上，通常是配偶或伴侣，他们感受到提供身体和支持性护理的巨大压力，但往往缺乏知识和技能造成严重的照顾者负担和痛苦，并可能导致丧亲之痛。这项前瞻性临床试验旨在测试电信系统。通过电话进行症状护理 - 临终关怀中心旨在弥合家庭和姑息治疗之间的鸿沟，为患者提供支持生命的终结和他们的家庭照顾者。 SCP-临终关怀中心具有三个要素：1）每日监控 12 生命中常见的症状，2) 自动向临终关怀 RN 病例经理发出有关症状的警报已经超过症状严重程度或痛苦的预设阈值，以及 3) 及时自动化，为护理人员实施量身定制的护理管理策略，以解决患者的症状。护理人员每天致电 SCP-Hospice 系统报告患者症状，然后立即提供服务与特定症状相匹配的自动化、量身定制的护理建议。样本将包括 300 名 50 岁以上癌症患者的配偶/伴侣照顾者加入家庭临终关怀计划并担任临终关怀注册护士案例经理。护理人员参与者将随机接受 SCP 临终关怀干预或常规临终关怀护理。该研究的具体目的是测试 SCP-临终关怀干预是否可以减轻严重程度并 12 种不同症状带来的痛苦以及是否可以减轻看护者的负担、焦虑、抑郁情绪与常规护理相比，护理人员可以减轻患者症状带来的痛苦，并改善护理人员的睡眠质量。还将探讨解释 SCP-临终关怀如何影响这些结果的机制。其他目标将比较护理人员使用的患者护理策略并评估护理人员和临终关怀注册护士的满意度与SCP系统。此外，利用该计划项目中其他两个研究项目的数据，两个协同目标将检查 SCP 干预对临终关怀 RN 护理人员质量的影响就未缓解的症状进行沟通，并确定护理人员是否使用 SCP-Hospice 与常规护理相比，在丧亲之痛期间经历的抑郁更少，适应能力也更好。