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、预期悲伤、负担和完成，并提高患者的生活质量和医疗保健利用率。如果有效，干预措施（Caregver Outlook）将提供一种简短、廉价且可移动的非医生治疗方法，以改善退伍军人及其护理人员临终时的体验。 非正式护理人员为临终患者提供大部分护理。改善护理人员和患者体验的努力通常集中在疼痛和症状管理以及应对技能上。然而，对于解决护理人员角色中其他可能提高护理能力的因素（即他们与患者的关系）的有效方法知之甚少。这种关系经历的两个重要要素是临终准备和完成。如果无人看管，护理人员可能会发现自己照顾亲人的能力下降，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以及健康沟通和临床心理学的有力证据设计了看护者展望干预措施，解决了表达情绪和压力对健康结果的价值。 我们的具体目标是： 1) 评估看护者展望干预对看护者焦虑、抑郁、预期悲伤、完成度和负担的影响； 2) 评估护理人员展望干预对患者健康服务利用的影响，以在家中与在医院、急诊室或护理机构的天数来衡量； 3）评估照顾者展望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、社会经济地位、家庭沟通质量和疾病阶段相关的变化，以提高对干预机制变化的理解。 我们提出一项随机对照试验来评估干预措施。 214 名患有晚期癌症、CHF 或 COPD 的护理人员和退伍军人将被随机分配到两个干预组之一，并完成一系列简短的预测试措施。第一组（“治疗”）中的护理人员将与协调员会面三次，每次四十五分钟。在第一节中，受试者将被要求讨论与关系生活回顾相关的问题。在第二节中，参与者将被要求更深入地谈论遗憾和宽恕等问题。在最后的会议中，主题将集中在遗产和庆祝活动上。护理人员在 第二组（“注意力控制”）将与辅导员会面三次，每次四十五分钟，并被要求听一张非引导式放松 CD。两组参与者都将接受由盲态访谈员管理的测试前和测试后措施。 结果将使用 FACT-G 和生活质量量表、FACIT-sp 量表、抑郁流行病学研究中心简表、情绪焦虑量表、预期悲伤量表、看护者反应评估来衡量、QUAL-E 完成和准备子量表，以及患者在家的天数。