SmartCare: Innovations in Caregiving Interventions

SmartCare：护理干预的创新

• 批准号: 8551701
• 负责人: Heidi S Donovan
• 金额: $ 61.55万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-27 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8551701
• 关键词: Accounting; Address; Adopted; Adult; Anxiety; Behavioral; Behavioral Sciences; Cancer Center; Caregiver Burden; Caregivers; Caring; Chronic Disease; Clinic; Cognitive; Data; Dementia; Diagnosis; Distress; Educational process of instructing; Face; Family; Family Caregiver; Family member; Floor; Goals; Hallucinations; Health; High Prevalence; Home environment; Interleukin-6; Intervention; Intervention Studies; Malignant neoplasm of brain; Measures; Mediating; Mental Health; Meta-Analysis; Modeling; Nerve Degeneration; Online Systems; Outcome; Outcome Study; Patients; Persons; Quality of Care; Quality of life; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Priority; Risk; Sampling; Science; Site; Symptoms; Telephone; Terminal Disease; Time; Translations; United States; University of Pittsburgh Cancer Institute; arm; base; caregiving; comparative efficacy; depressive symptoms; design; economic impact; evidence base; immune function; improved; innovation; mortality; neuro-oncology; new technology; novel strategies; oncology; physical conditioning; psychologic; psychological outcomes; public health relevance; response

DESCRIPTION (provided by applicant): Multiple studies have shown that the psychological and physical consequences of providing care to a family member with a chronic illness can include anxiety, depressive symptoms, burden, altered immune function, poor overall health, and increased overall mortality. Family caregivers of persons with a primary malignant brain tumor (PMBT) are at particular risk for poor outcomes as they face both oncologic and neurodegenerative issues. Multiple caregiver interventions aimed at improving caregivers' psychological health have been evaluated, yet meta-analyses fail to demonstrate consistently strong effect sizes. As a result of research suggesting that depressive symptoms interfere with a person's ability to engage in and benefit from intervention, we hypothesize that current caregiver interventions have not demonstrated large effect sizes because they have not addressed pre-existing levels of depressive symptoms. The long term goals of the project are to identify the most effective ways to deliver interventions to improve the psychological and physical health of family caregivers. The specific aims of this multi-site three arm randomized controlled trial are to: 1) Compare the efficacy of a) an intervention for depressive symptoms (Beating the Blues) delivered prior to a needs-based caregiver intervention (SmartCare(c)) versus b) SmartCare(c) alone versus c) enhanced care as usual (CAU+) in improving caregivers' psychological and physical health and 2) Compare the efficacy of Beating the Blues versus CAU+ in improving subjects' short- term psychological and physical health. We also plan to explore 1) whether any changes in psychological and physical health resulting from receiving Beating the Blues prior to SmartCare(c) or SmartCare(c) alone are maintained at 10-months after baseline and 2) whether the effect of Beating the Blues + SmartCare(c) (vs. SmartCare(c) alone) on 4- and 6-month psychological and physical responses is mediated by 0- to 2-month changes in depressive symptoms. We will be recruiting 210 caregiver/care recipient dyads from the University of Pittsburgh Cancer Institute and MD Anderson Cancer Center neuro-oncology clinics. Repeated measures modeling using general linear mixed models will investigate the relationship of group assignment with psychological and physical outcomes over time. The proposed study addresses research priorities set by both NCI and NINR to improve the quality of life of patients and their families and NINR's emphasis on integrating bio-behavioral science and adopting, adapting and generating new technologies. The significance of the project is great in terms of its potential societal and economic impact. The web-based and telephone intervention delivery allows for easy translation and should the hypotheses be supported, this trial could fundamentally change how caregiver interventions are delivered.

描述（由申请人提供）：多项研究表明，向患有慢性疾病的家庭成员提供护理的心理和身体后果可能包括焦虑，抑郁症状，负担，免疫功能改变，整体健康状况不佳以及总体死亡率提高。患有原发性恶性脑肿瘤（PMBT）患者的家庭护理人员尤其面临肿瘤学和神经退行性问题，因此患有较差的结果。已经评估了旨在改善护理人员心理健康的多重护理人员干预措施，但荟萃分析未能证明始终如一的强大效果大小。由于研究表明，抑郁症状会干扰一个人参与干预和受益于干预的能力，我们假设当前的护理人员干预措施尚未表现出很大的效果大小，因为它们尚未解决抑郁症状的先前水平。该项目的长期目标是确定提供干预措施以改善家庭护理人员的心理和身体健康的最有效方法。这个多站点的三个手臂随机对照试验的具体目的是：1）比较a）在基于需求的护理人员干预（smartcare（c））与智能保健（c）的抑郁症状（击败蓝调）的干预措施（击败蓝调）之前，单单与c的智能疗法和c的效果（CAU+）效果（CAU+）的效果（CAU+）的效果（CAU+），并进行了效果（CAU+）。在改善受试者的短期心理和身体健康方面，蓝调与CAU+。我们还计划探索1）1）是否会在基线后10个月和2个单独的智能保健（c）或智能保健（c）和智能保健（c）在基线后的10个月和2）击败布鲁斯 +智能保健（c）的效果（vs. smartcare（c）单独使用4--和6个月的心理响应，是否会在精神上和6个月的频率上进行效果，是否会在基准后的10个月和2）中保持在心理 +智能保健（c）的效果中是否会保持在心理和6个月的频率上，是否将其保持在心理和6个月之间，是否是否会在心理和6个月中进行效果，是否将其保持在4-和6个月的频率。我们将从匹兹堡大学癌症研究所和医学博士安德森癌症中心神经肿瘤诊所招募210名看护人/护理人员二元组。使用一般线性混合模型进行重复测量，将研究小组分配与心理和身体结果的关系。拟议的研究涉及NCI和NINR设定的研究优先级，以改善患者及其家人的生活质量，并强调将生物行为科学和采用，适应和生成新技术的重点。就其潜在的社会和经济影响而言，该项目的重要性很大。基于网络的和电话干预交付可以轻松翻译，如果支持假设，该试验可能从根本上改变了护理人员的干预方式。