Navigating Advanced Illness for Informal Caregivers of Ill Veterans

为患病退伍军人的非正式护理人员应对晚期疾病

• 批准号: 10486017
• 负责人: Nathan Adam Boucher
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10486017
• 关键词: Academy; Address; Advance Care Planning; Age; Aging; American; Area; Award; Behavioral Model; Caregiver Burden; Caregiver support; Caregivers; Caring; Chronic; Chronic Disease; Chronic Obstructive Pulmonary Disease; Clinical; Communities; Community Healthcare; Complex; Coupled; Data; Dementia; Education; Educational Curriculum; Effectiveness; Effectiveness of Interventions; Face; Financial Hardship; Food; Future; Goals; Health; Health Care Costs; Health Services; Health Services Accessibility; Health Services Research; Health Status; Home; Impairment; Income; Intervention; Interview; Knowledge; Link; Long-Term Care; Malignant Neoplasms; Mediation; Modeling; Needs Assessment; Outcome; Palliative Care; Patients; Personal Satisfaction; Persons; Pilot Projects; Play; Positioning Attribute; Process; Provider; Psychosocial Assessment and Care; Quality of life; Recommendation; Reporting; Research; Research Personnel; Research Priority; Resources; Role; Sampling; Screening for cancer; Secondary to; Services; Social support; Stroke; Testing; Training; Transportation; Traumatic Brain Injury; Veterans; Work; acceptability and feasibility; advanced disease; age group; care coordination; care recipients; career; caregiving; community organizations; coping; disability; efficacy evaluation; empowerment; experience; falls; follow-up; health care model; high risk; human old age (65+); improved; informal caregiver; informant; innovation; intervention cost; loved ones; meetings; member; navigator intervention; novel; patient navigation; physical conditioning; post 9/11; preference; programs; prospective; repaired; research and development; skill acquisition; skills; social; therapy development

Project Summary/Abstract Of the 65 million Americans who serve as informal caregivers of persons with chronic disability or illness, about 5.5 million are caring for Veterans. These caregivers play a significant role in helping to maintain the health and well-being of Veterans and often experience significant burden related to their caregiving role, including poor physical health, financial difficulties, and low confidence in the care they provide. Current VA programs aim to improve caregivers' knowledge and ability to provide direct care at home to patients with dementia, TBI, cancer, and stroke. However, these programs have a number of limitations. First, they are not always able to respond to caregivers' social and practical needs adequately. Second, caregivers of seriously ill Veterans ≥ age 65 living in the community, an age group with high risk for unmet needs secondary to chronic illness and impairment, may not always get needed services due to an emphasis on post 9/11 Veterans and their caregivers. Third, they do not focus specifically on helping caregivers to navigate existing resources to meet their social and practical needs. Based on evidence of their effectiveness in other settings, health navigator programs may help address unmet social and practical needs of caregivers and reduce caregiver burden by providing direct linkages to services and other resources. This CDA proposes to develop a novel, effective navigator intervention targeting caregivers of older, community-dwelling Veterans with advanced illness. In prior work, patient navigation programs have facilitated cancer screening, clinical follow-up, advance care planning, psychosocial support, and care coordination. The central hypothesis is that a novel adaptation of established models of navigation can improve the ability of caregivers to care for older Veterans with advanced illness (cancer, COPD, or CHF) if it is: 1) informed by caregivers and patients themselves along with other VA and community stakeholders; and 2) focused on identifying and supporting social support and practical needs using both VA and community resources. To evaluate this hypothesis, three complementary, but distinct specific aims are proposed: (Aim 1) Assess social and practical needs of caregivers of older (≥ age 65) community-dwelling Veterans with advanced illness and their preferences for intervention. This aim will include prospectively conducted key-informant interviews with seriously ill Veterans and caregivers coupled with input from a Stakeholder Advisory Board which includes Veterans, caregivers, VA providers, and community organization membership (e.g., Area Agency on Aging); (Aim 2) Using data from Aim 1, develop a curriculum to train navigators to identify caregiver needs and link them to resources within VA and their community to address those needs; and (Aim 3) In a pilot study, assess feasibility and acceptability of a caregiver navigator intervention in meeting the social and practical needs of caregivers of community-dwelling older veterans with advanced illness by increasing knowledge of and access to services and resources. The findings of this study will lead to a novel intervention which may significantly reduce caregiver burden and, in so doing, improve the care of community dwelling veterans with advanced illness. This is consistent with VA's Health Services Research and Development priority of improving caregiving and long- term care in service to Veterans. The effectiveness of the intervention developed in this CDA can be further tested in a large, RCT supported by an IIR Merit Award.

项目摘要/摘要 在6,500万美国人中，他们是慢性残疾人或 疾病，约有550万正在照顾退伍军人。这些护理人员在帮助维护方面发挥了重要作用 退伍军人的健康和福祉，经常与他们的护理角色有关 当前的VA包括身体健康不良，财务困难以及对他们提供的护理的信心较低。 计划旨在提高看护人的知识和能力，以便为有 痴呆，TBI，癌症和中风。但是，这些程序有许多局限性。首先，他们不是 始终能够充分满足照顾者的社会和实际需求。第二，生病的护理人员 退伍军人≥65岁的社区生活，一个年龄段的年龄段未满足的高风险继发于慢性 疾病和损害，由于强调9/11后退伍军人和 他们的照顾者。第三，他们并不专门专门用于帮助护理人员浏览现有资源 满足他们的社会和实际需求。根据其在其他环境中有效性的证据，健康 导航器计划可能有助于满足未满足的护理人员的社会和实际需求，并减少护理人员 通过与服务和其他资源的直接联系，Burnen。 这项CDA提出的提案是针对较旧的护理人员的新颖，有效的导航器干预措施 患有晚期疾病的社区老兵。在先前的工作中，患者导航计划已准备好 癌症筛查，临床随访，预先护理计划，社会心理支持和护理协调。这 中心假设是，对已建立导航模型的新颖适应可以提高 照顾者照顾患有晚期疾病的老年退伍军人（癌症，COPD或CHF），如果是：1） 护理人员和患者本身以及其他VA和社区利益相关者； 2）专注于 使用VA和社区资源确定和支持社会支持和实际需求。到 评估这一假设，提出了三个完整但独特的特定目的：（目标1）评估社会 以及老年人（≥65岁）患有晚期疾病和 他们对干预的偏好。这个目标将包括前瞻性进行的密钥信息采访 认真生病的退伍军人和看护人，加上利益相关顾问委员会的意见，包括 退伍军人，护理人员，弗吉尼亚州提供者和社区组织成员资格（例如，老龄化区域机构）； （AIM 2）使用AIM 1的数据，开发课程来培训导航员以确定护理人员的需求并链接 他们向弗吉尼亚州及其社区内的资源来满足这些需求； （目标3）在试点研究中，评估 护理人员导航员干预的可行性和可接受性，以满足社会和实际需求 通过越来越多的知识和访问知识， 到服务和资源。 这项研究的发现将导致新的干预措施，可能会大大减少护理人员 负担以及这样做，可以改善对患有晚期疾病的社区住宅退伍军人的护理。这是 与VA的健康服务研究和发展优先级相一致，以改善护理和长期 为退伍军人服务期限。在本CDA中开发的干预措施的有效性可以进一步 在IIR功绩奖的大型RCT中进行了测试。

项目成果

Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design.

• DOI: 10.1186/s12913-021-06448-7
• 发表时间: 2021-05-06
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: Boucher NA;Zullig LL;Shepherd-Banigan M;Decosimo KP;Dadolf J;Choate A;Mahanna EP;Sperber NR;Wang V;Allen KA;Hastings SN;Van Houtven CH
• 通讯作者: Van Houtven CH

Frontline Clinician Appraisement of Research Engagement: "I feel out of touch with research".

• DOI: 10.1007/s11606-023-08200-9
• 发表时间: 2023-09
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Boucher NA;Tucker MC;White BS;Ear B;Dubey M;Byrd KG;Williams JW Jr;Gierisch JM
• 通讯作者: Gierisch JM