A communication-based intervention for advanced cancer patient-caregiver dyads to increase engagement in advance care planning and reduce caregiver burden

针对晚期癌症患者-护理人员二人组的基于沟通的干预措施，以增加对预先护理计划的参与并减轻护理人员的负担

• 批准号: 9789230
• 负责人: Kelly McConnell
• 金额: $ 22.18万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789230
• 关键词: Address; Adherence; Advance Care Planning; Advanced Malignant Neoplasm; Benchmarking; Breathing; Cancer Center; Cancer Patient; Caregiver Burden; Caregivers; Caring; Cessation of life; Cognitive; Collaborations; Communication; Decision Making; Distress; Do Not Resuscitate Order; Family; Feedback; Foundations; Friends; Fright; Future; Goals; Health Care Costs; Healthcare; Home environment; Intervention; Learning; Life; Life Expectancy; Living Wills; Measures; Methods; Muscle relaxation phase; Nature; Outcome; Palliative Care; Participant; Patient Care; Patient Self-Report; Patients; Play; Proxy; Public Health; Quality of Care; Randomized Clinical Trials; Relaxation Techniques; Reporting; Research; Research Personnel; Role; Surgeon; Techniques; Telephone; Terminally Ill; Testing; Treatment Efficacy; Treatment Futility; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Validation; Work; base; cancer care; caregiver bereavement; college; distress tolerance; emotional distress; end of life; end of life care; experience; health care service utilization; health goals; improved; innovation; member; novel; novel strategies; outcome forecast; participant retention; patient engagement; post intervention; preference; primary outcome; prognostic; programs; psychological distress; psychosocial; response; satisfaction; secondary outcome; skills; social; standard care; theories; therapy design

PROJECT SUMMARY Accurate prognostic understanding is a critical predictor of patients' engagement in advance care planning (ACP) and receipt of less futile, aggressive care at the end of life. However, approximately half of advanced cancer patients do not understand the terminal nature of their illness. Caregivers play an integral role in patients' care and decision-making at the end of life, yet few interventions include them. Drs. Shen and Trevino's pilot work, in collaboration with their Co-Investigators Drs. Prigerson and Maciejewski, suggests that improving both patient and caregiver prognostic understanding surrounding the patient's terminal status and estimated life expectancy is associated with higher rates of engagement in ACP. Based on this pilot work and the important role of caregivers in end-of life (EOL) cancer care, this study aims to develop a communication- based intervention to improve advanced cancer patients' and caregivers' prognostic understanding. The goals of this study are to: (1) develop a communication-based intervention to improve advanced cancer patients' and caregivers' prognostic understanding using communication strategies (e.g., acknowledgment, validation of fears) and distress management techniques (e.g., deep breathing, muscle relaxation); (2) evaluate the feasibility and acceptability of the intervention among advanced cancer patients and their caregivers; and (3) test the preliminary efficacy of the intervention on patients' and caregivers' prognostic understanding (primary outcome); completion of DNR order, living will, and health care proxy; psychological distress; communication quality; caregiver burden; and healthcare utilization (secondary outcomes). To meet these goals, we will collect feedback from advanced cancer patients and their caregivers (n=10 dyads) and psychosocial experts (n=10) to improve and refine the intervention. Next, we will pilot test the intervention with n=30 patient-caregiver dyads and assess outcomes at baseline, post-intervention, and three months later to determine the feasibility, acceptability, and preliminary efficacy of the intervention on improving engagement in ACP and communication, reducing distress and caregiver burden, improving rates of goal-concordant care, and reducing rates of futile aggressive care. These results will inform a future NIH R01 application to conduct a large-scale randomized clinical trial (RCT) of intervention efficacy. Grounded in established theories of inhibitory learning and social-cognitive processing, the present study takes the novel approach of integrating communication and distress management techniques to improve patients' and caregivers' ability to discuss difficult EOL topics while managing the distress associated with these topics. It is expected that these results will form a strong foundation for a program of research focused on integrating caregivers into interventions targeting advanced cancer patients as a novel and innovative way to improve engagement in ACP, increase rates of goal- concordant care, and reduce receipt of futile, aggressive EOL care.

项目摘要 准确的预后理解是患者参与预先护理计划的关键预测指标 （ACP）并在生命的尽头接受少于徒劳的积极护理。但是，大约一半的高级 癌症患者不了解其疾病的终极性质。照顾者在 患者在生命结束时的护理和决策，但很少有干预措施包括他们。博士。沉和 特雷维诺（Trevino）的飞行员工作与他们的共同投资者DRS合作。 Prigerson和Maciejewski，建议 改善患者和护理人员的预后理解，围绕患者的最终状况和 估计的预期寿命与较高的ACP参与率有关。基于此试点工作， 护理人员在终结（EOL）癌症护理中的重要作用，本研究旨在发展交流 - 基于改善晚期癌症患者和看护人的预后理解的干预措施。目标 这项研究的是：（1）开发基于传播的干预措施，以改善晚期癌症患者和 护理人员使用沟通策略的预后理解（例如，确认，验证 恐惧）和遇险管理技术（例如，深呼吸，肌肉放松）； （2）评估 晚期癌症患者及其护理人员干预的可行性和可接受性； （3） 测试干预对患者和护理人员预后理解的初步疗效（主要 结果）;完成DNR命令，生活意志和医疗保健代理；心理困扰；沟通 质量;照顾者负担；和医疗保健利用（次要结果）。为了实现这些目标，我们将收集 来自晚期癌症患者及其护理人员的反馈（n = 10个二元组）和社会心理专家（n = 10） 改善并完善干预措施。下一 并在基线，干预后和三个月后评估结果，以确定可行性， 可接受性以及干预措施在改善ACP和 沟通，减轻困扰和照顾者负担，提高目标协同保健的速度并降低 徒劳的积极护理率。这些结果将为未来的NIH R01申请提供大规模进行的申请 干预功效的随机临床试验（RCT）。基于既定的抑制性学习理论 和社会认知处理，本研究采用了整合沟通和 遇险管理技术，以改善患者和看护人讨论困难的EOL主题的能力 在管理与这些主题相关的困扰的同时。预计这些结果将形成强大 集中于将护理人员整合到针对高级干预措施中的研究计划的基础 癌症患者是一种新颖而创新的方法来提高参与ACP的参与，提高目标率 一致的护理，并减少徒劳的，积极的EOL护理。