Building Family Caregiver Skills Using a Simulation-Based Intervention for Care of Patients with Cancer

使用基于模拟的干预措施来培养癌症患者的家庭护理人员技能

基本信息

批准号：
10206068
负责人：
Susan Mazanec
金额：
$ 57.64万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10206068
关键词：
Active Learning Address Adverse event Affect Anus Anxiety Cancer Center Cancer Family Caregivers Caring Clinical Colostomy Procedure Combined Modality Therapy Communication Complex Comprehensive Cancer Center Control Groups Data Decision Making Dehydration Demographic Factors Distress Division of Cancer Control and Population Sciences Education Educational Intervention Educational process of instructing Effectiveness Emergency department visit Emotional Enteral Feeding Event Face Family Family Caregiver Family member Fatigue Feeling Goals Head Cancer Head and neck structure Health Health Care Costs Health Professional Healthcare Systems Hospitalization Hour IV Fluid Impairment Individual Interruption Intervention Intravenous Lead Location Malignant Neoplasms Malignant neoplasm of anus Malignant neoplasm of esophagus Malignant neoplasm of lung Malnutrition Measures Mediating Mediation Medical Care Team Mental Depression Methods Mission Modality Modeling National Cancer Institute Neck Cancer Non-Small-Cell Lung Carcinoma Nutritional Oncology Operative Surgical Procedures Outcome Pain management Patient Care Patient-Focused Outcomes Patients Persons Play Population Preparation Problem Solving Process Prognosis Psychosocial Influences Quality of Care Radiation Radiation therapy Randomized Controlled Trials Rectal Cancer Reporting Research Role Self Efficacy Self Management Skin Structure Symptoms Techniques Telephone Testing Time Tracheostomy procedure Training Translating Treatment Side Effects Treatment outcome University Hospitals Well in self base cancer therapy care delivery care recipients caregiver education caregiver interventions caregiving chemotherapy clinical practice design educational atmosphere experience family building family management functional disability health care service utilization health related quality of life improved intervention effect novel point of care primary caregiver prospective psychoeducational psychoeducational intervention psychological distress randomized trial recruit rectal simulation skill acquisition skills skills training survivorship symptom management usual care arm virtual wound

项目摘要

Project Summary/Abstract: Patients with head and neck, lung, esophageal, rectal, and anal cancers typically undergo rigorous, intense, combined-modality treatment (radiation, surgery, and/or chemotherapy) and experience high symptom burden, functional impairment, and complex psychosocial issues. Positive treatment outcomes and avoidance of complications are dependent largely on the adequacy of care provided by family members. However, family caregivers (CGs) report feeling unprepared to assume the multiple, complex tasks of caregiving, including tangible help with tracheostomy care, tube feedings, wound and colostomy care, pain management, and ongoing emotional support. Despite being a critical extension of the oncology healthcare team, training of CGs to manage symptoms, deal with communication issues with care recipients, and take care of their own physical and emotional health, is not integrated into clinical practice. This study will measure the effect of a psychoeducational and skills training intervention that incorporates structured simulation or experiential learning to improve CG, patient, and healthcare utilization outcomes. Simulation is effective in training healthcare professionals, but little is known about its effectiveness in training family CGs. The intervention is designed for the period of active cancer treatment and the immediate transition to posttreatment survivorship, a time when the CG and patient are most vulnerable. The specific aims of this 2-group, prospective, randomized controlled trial are to: (1) evaluate the effect of a CG intervention, as compared to a control group, on CG primary (anxiety) and secondary (depression, health-related quality of life [HRQOL], and fatigue) outcomes; (2) measure the effect of the intervention on patient outcomes (HRQOL and interrupted treatment course) and healthcare utilization outcomes (unplanned hospital admission, unplanned emergency room visits, and unplanned use of intravenous fluids); (3) determine if CG self-efficacy mediates the effect of the intervention on CG anxiety; (4) determine if patient illness factors, care demands, and patient and CG demographic factors moderate the relationship between the intervention and CG outcomes; and (5) compare the costs of healthcare utilization between the intervention and control groups. We will recruit 180 CGs from University Hospitals Seidman Cancer Center at the Case Comprehensive Cancer Center. The intervention involves three in-person, one-on-one sessions during radiation treatments, followed by a telephone contact 2 weeks posttreatment. Data will be collected at baseline, at the end of radiation treatment, and 4 and 20 weeks postradiation treatment. The analysis will consist of linear mixed model repeated measures, mediation and moderation tests, and Poisson regression methods. The proposed project addresses National Cancer Institute's Division of Cancer Control and Population Sciences mission of improving the delivery of care to individuals and family members affected by cancer. The study findings will provide crucial information for translating the psychoeducational and simulation methods used in this intervention to other CG populations and clinical settings.

项目摘要/摘要：患有头颈癌、肺癌、食道癌、直肠癌和肛门癌的患者通常会经历严格、强烈、联合治疗（放射、手术和/或化疗）并经历高症状负担，功能障碍和复杂的社会心理问题。积极的治疗结果和避免并发症很大程度上取决于家庭成员提供的护理是否充分。然而，家人护理人员 (CG) 表示感觉没有准备好承担多项复杂的护理任务，包括在气管造口护理、管饲、伤口和结肠造口护理、疼痛管理以及持续的情感支持。尽管 CG 培训是肿瘤医疗团队的重要延伸管理症状，处理与护理接受者的沟通问题，并照顾自己的身体和情绪健康，没有融入临床实践。这项研究将衡量结合结构化模拟或体验式的心理教育和技能培训干预学习改善 CG、患者和医疗保健利用结果。模拟训练有效医疗保健专业人士，但对其在培训家庭 CG 方面的有效性知之甚少。干预措施是专为积极癌症治疗期间和立即过渡到治疗后生存期而设计， CG 和患者最脆弱的时候。这两组前瞻性随机研究的具体目标对照试验的目的是：(1) 与对照组相比，评估 CG 干预对 CG 的影响主要（焦虑）和次要（抑郁、健康相关生活质量 [HRQOL] 和疲劳）结果； (2) 衡量干预对患者结果的影响（HRQOL 和中断的治疗过程）以及医疗保健利用结果（计划外入院、计划外急诊室就诊以及计划外使用静脉输液）； (3) 确定CG自我效能感是否介导了干预的效果 CG焦虑； (4) 确定患者疾病因素、护理需求以及患者和 CG 人口统计因素调节干预措施与 CG 结果之间的关系； (5) 比较医疗保健费用干预组和对照组之间的利用。我们将从大学医院招募180名CG 凯斯综合癌症中心的塞德曼癌症中心。干预涉及三人亲自参与，放射治疗期间进行一对一的咨询，治疗后两周进行电话联系。数据将在基线、放射治疗结束时以及放射治疗后 4 周和 20 周时收集。该分析将包括线性混合模型重复测量、中介和调节测试，以及泊松回归方法。拟议项目涉及国家癌症研究所癌症部门控制与人口科学的使命是改善对个人和家庭成员的护理服务受癌症影响。研究结果将为转化心理教育和本次干预中使用的模拟方法对其他 CG 人群和临床环境进行干预。