Impact of a Novel Cancer Communication Intervention on Caregiver Bereavement

新型癌症沟通干预措施对照顾者丧亲之痛的影响

• 批准号: 8990824
• 负责人: PAUL R DUBERSTEIN
• 金额: $ 70.84万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-23 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8990824
• 关键词: Adult; Advanced Malignant Neoplasm; Affect; Anxiety; Audiotape; Bereavement; Cancer Intervention; Caregivers; Caring; Cessation of life; Coercion; Communication; Consent; Data Collection; Decision Making; Diagnosis; Elements; Enrollment; Family; Family Caregiver; Family member; Feedback; Friends; Funding; Grief reaction; Health; Health Communication; Health Policy; Healthcare; Intensive Care; Intervention; Interview; Lead; Life; Link; Malignant Neoplasms; Mediating; Mental Depression; Mental Health; Morbidity - disease rate; Oncologist; Outcome; Parents; Participant; Patient Preferences; Patient Self-Report; Patient-Focused Outcomes; Patients; Personal Satisfaction; Physical Function; Physicians; Preventive; Process; Public Health; Qualitative Methods; Quality of life; Randomized; Randomized Clinical Trials; Regrets; Reporting; Research; Risk; SF-36; Sampling; Site; Solid; Suicide; Symptoms; Thinking; Uncertainty; United States; United States National Institutes of Health; Visit; arm; base; cancer care; cancer diagnosis; caregiver bereavement; caregiver interventions; clinical decision-making; depressive symptoms; design; disability; experience; group intervention; health care service utilization; improved; informal caregiver; innovation; intervention effect; novel; outcome forecast; outreach; physical conditioning; primary outcome; prospective; response; secondary outcome; skills; treatment as usual; treatment choice

DESCRIPTION (provided by applicant): Family caregivers of patients with advanced cancer are at risk for bereavement- related morbidity. Better communication in the context of cancer care may improve health outcomes of the bereaved. Aims: In a study nested within a parent RCT (R01CA140419) focused on patient outcomes, we propose to examine whether a health communication intervention can lead to better caregiver mental health (Aim 1) and physical health (Aim 2). In Aim 3, we seek to contextualize these findings by conducting mediational analyses and qualitative analyses. The former will explore whether intervention effects are mediated by patient-reported quality of life and patient health care utilization. Qualitative methods will be used to link bereavement outcomes with parent study communication outcomes. Design: Multiple waves of caregiver assessments will be added to a NIH-funded two-site cluster RCT. In that study, oncologists are randomized to usual-care (n=15) or the communication intervention (n=15), which involves two in-office sessions providing individually tailored feedback on their patient communication skills. Patients with advanced cancer and their caregivers seen by oncologists in the usual-care arm (n=128 dyads) will receive usual cancer care. Dyads seen by oncologists in the intervention arm (n=128 dyads) will receive pre-visit coaching and question- prompt lists to enhance their communication skills. In this application, we propose to assess caregiver experiences and outcomes while the patients are alive, as well as 2 and 7 months after the patients' deaths. The 2-month post-mortem assessment will include an audiotaped interview to explore caregivers' experiences with key elements of decision-making: information exchange (e.g., tailored), deliberation (e.g. participation), and socioemotional issues (e.g. respect, abandonment). Main outcomes: Prolonged grief symptoms (PG-13) and physical function (SF-36) 7 months following the patients' deaths. Secondary outcomes include symptoms of depression and anxiety, decisional regret, thoughts of suicide, and disability. For the qualitative analyses, criterion based purposeful sampling will be used to make deliberate comparisons linking the parent study and this one based on 3 criteria: intervention arm, communication quality, and prolonged grief. Significance: This efficient addition to an ongoing RCT is the first attempt to examine the effects on bereavement outcomes of an intervention that could be integrated into routine cancer care. As the intervention is systemic, yet simple and readily disseminated, findings will have implications for cancer care, public health, and policy.

描述（由申请人提供）：晚期癌症患者的家庭护理人员面临与丧亲之痛相关的发病风险。在癌症护理方面更好的沟通可能会改善死者家属的健康状况。目标：在一项针对患者结果的随机对照试验 (R01CA140419) 中，我们建议研究健康沟通干预措施是否可以改善护理人员的心理健康（目标 1）和身体健康（目标 2）。在目标 3 中，我们寻求通过进行中介分析和定性分析来将这些发现结合起来。前者将探讨干预效果是否由患者报告的生活质量和患者医疗保健利用率介导。将使用定性方法将丧亲结果与家长研究沟通结果联系起来。设计：美国国立卫生研究院 (NIH) 资助的两地集群随机对照试验中将添加多轮护理人员评估。在该研究中，肿瘤科医生被随机分配到常规护理（n=15）或沟通干预（n=15），其中涉及两次办公室会议，提供针对患者沟通技巧的个性化反馈。常规护理组中肿瘤科医生看过的晚期癌症患者及其护理人员（n=128 组）将接受常规癌症护理。肿瘤科医生在干预组中看到的二人组（n = 128 二人组）将接受就诊前的指导和问题提示列表，以提高他们的沟通技巧。在此应用中，我们建议评估患者活着时以及患者死亡后 2 个月和 7 个月时的护理人员经历和结果。为期 2 个月的尸检评估将包括录音采访，以探讨护理人员在决策关键要素方面的经历：信息交换（例如定制）、审议（例如参与）和社会情感问题（例如尊重、遗弃）。主要结果：患者死亡后 7 个月的长期悲伤症状 (PG-13) 和身体功能 (SF-36)。次要结局包括抑郁和焦虑症状、决策后悔、自杀念头和残疾。对于定性分析，将使用基于标准的有目的抽样，根据 3 个标准将母研究与本研究进行深思熟虑的比较：干预组、沟通质量和长期悲伤。意义：这项对正在进行的随机对照试验的有效补充是首次尝试检查可纳入常规癌症护理的干预措施对丧亲结果的影响。由于干预措施是系统性的，但简单且易于传播，研究结果将对癌症护理、公共卫生和政策产生影响。