Caregiver Outlook: An Intervention to Improve Caregiving in Serious Illness

护理人员展望：改善重病护理的干预措施

• 批准号: 8696649
• 负责人: Karen E Steinhauser
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-11-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8696649
• 关键词: Accident and Emergency department; Address; Advanced Malignant Neoplasm; Anxiety; Attention; Blinded; Breast; Caregivers; Caring; Chronic Obstructive Airway Disease; Clinical; Clinical Psychology; Code; Communication; Conflict (Psychology); Coping Skills; Discipline of Nursing; Economics; Education; Elements; Emotional; Epidemiologic Studies; Ethnic Origin; Expressed Emotion; Face; Family; Family Caregiver; Fostering; Friends; Funding; Gender; Grief reaction; Hair; Health; Health Communication; Health Personnel; Health Services; Home environment; Hospitals; Human Development; Husband; Institution; Intervention; Interviewer; Lead; Left; Life; Literature; Measures; Mental Depression; Methods; Moods; Outcome; Pain management; Palliative Care; Participant; Patient Care; Patients; Persons; Policies; Population; Pre-Post Tests; Preparation; Provider; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Reaction; Regrets; Relaxation; Research; Resources; Role; Services; Specific qualifier value; Staging; Stress; Testing; Time; Training; Variant; Veterans; Walking; advanced disease; base; caregiver education; caregiving; coping; design; effective intervention; end of life; experience; forgiveness; group intervention; health care service utilization; hospice environment; improved; loved ones; meetings; social; symptom management

DESCRIPTION (provided by applicant): This study will demonstrate whether an end-of-life preparation and completion intervention improves reduces caregiver anxiety, depression, anticipatory grief, burden and completion and improves patient quality of life and health care utilization. If effective, the intervention (Caregver Outlook) offers a brief, inexpensive, and transportable non-physician treatment method for improving the experience of veterans and their caregivers at end-of-life. Informal caregivers provide a majority of care for patients at the end of life. Efforts to improve caregiver and thus patient experience often focus on pain and symptom management and coping skills. However, less is known about effective ways to address other elements of caregivers' role that may increase capacity to care, namely their relationship to the patient. Two important elements of this relationship experience are end-of-life preparation and completion. Left unattended, caregivers may find themselves less capable of caring for a loved one and unable to make crucial decisions influencing care. We designed the Caregiver Outlook intervention, based on the human development literature and robust evidence in health communication and clinical psychology that addresses the value of expressing emotions and stress on health outcomes. Our specific aims are to: 1) Evaluate the impact of the Caregiver Outlook intervention on caregiver anxiety, depression, anticipatory grief, completion, and burden; 2) Evaluate the impact of the Caregiver Outlook intervention on patient health service utilization, as measured by number of days at home versus in hospital, emergency department, or nursing facility; 3) Evaluate the impact of the Caregiver Outlook intervention on quality of life in patients with advanced disease; 4) Analyze the intervention session's qualitative content, examining variation associated with gender, ethnicity, social economic status, quality of family communication, and stage of illness to improve understanding of the intervention mechanisms of change. We propose a randomized control trial to evaluate the intervention. Dyads of 214 caregivers and veterans with advanced cancer, CHF, or COPD will be randomly assigned into one of two intervention groups and complete a brief battery of pre-test measures. Caregivers in the first group ("treatment") will meet with a facilitator three times for a period of forty-five minutes eac. In the first session, subjects will be asked to discuss issues related to relationship life review.In session two, participants will be asked to speak in more depth about issues such as regret and forgiveness. In the final session, subjects will focus on legacy and celebration. Caregivers in the second group ("attention control") will meet with a facilitator three times for a period of forty-fve minutes each and be asked to listen to a non-guided relaxation CD. Participants in both groups will receive pre and post-test measures administered by a blinded interviewer. Outcomes will be measured using the FACT-G and quality of life scale, the FACIT-sp sub-scale, the Centers for Epidemiologic Study of Depression short form, the Profile of Moods anxiety sub-scale, the Anticipatory Grief Scale, Caregiver Reaction Assessment, the QUAL-E completion and preparation sub-scales, and patient days at home.

描述（由申请人提供）： 这项研究将证明临终准备和完成干预是否可以改善护理人员的焦虑，抑郁，预期的悲伤，负担和完成，并改善患者的生活质量和医疗保健利用。如果有效，干预措施（Caregver Outlook）提供了一种简短，便宜且可运输的非医学治疗方法，以改善退伍军人及其护理人员在终止生命中的经验。 非正式护理人员在生命结束时为患者提供大部分护理。改善护理人员的努力，因此患者的经验通常集中在疼痛和症状管理和应对技巧上。但是，关于解决护理人员角色的其他要素可能会增加护理能力的有效方法，即他们与患者的关系。这种关系经验的两个重要要素是临终准备和完成。剩下的无人看管，看护人可能会发现自己不太有能力照顾一个亲人，并且无法做出影响护理的关键决定。我们根据人类发展文献和健康沟通和临床心理学的强大证据设计了护理人员的前景干预措施，这些证据探讨了表达情绪和对健康结果的压力的价值。 我们的具体目的是：1）评估看护人前景干预对看护人焦虑，抑郁，预期悲伤，完成和负担的影响； 2）评估护理人员前景干预对患者卫生服务利用的影响，按照家庭的数量与医院，急诊室或护理设施的数量来衡量； 3）评估护理人员前景干预对晚期疾病患者生活质量的影响； 4）分析干预会议的定性内容，检查与性别，种族，社会经济状况，家庭交流质量和疾病阶段相关的差异，以提高人们对变化干预机制的理解。 我们提出了一项随机对照试验，以评估干预措施。 214名护理人员和患有晚期癌症，CHF或COPD的退伍军人的二元组将被随机分为两个干预组之一，并完成短暂的测试措施。第一组的护理人员（“治疗”）将与主持人见面三次，共45分钟。在第一届会议中，将要求受试者讨论与关系生活审查有关的问题。在第二节中，将要求参与者更深入地谈论诸如遗憾和宽恕之类的问题。在最后一次会议中，主题将重点关注遗产和庆祝活动。照顾者 第二组（“注意力控制”）将与一个协助者相遇3次，每次40分钟，并被要求听取非引导放松CD。这两个小组的参与者将获得盲人访调员管理的测试前和后测措施。 结果将使用FACT-G和质量量表，FACIT-SP子尺度，抑郁症短形式流行病学研究中心，情绪焦虑亚量表的概况，预期悲​​伤量表，护理人员反应评估，质量完成和制备子量表以及家中的患者日子。