The impact of a problem-solving intervention on increasing caregiver assistance and improving caregiver health.
The impact of a problem-solving intervention on increasing caregiver assistance and improving caregiver health.
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解决问题的干预措施对增加护理人员援助和改善护理人员健康的影响。
DOI：
10.1007/s00520-011-1295-5
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Prince,Jennifer
中科院分区：
文献类型：
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作者：
Sherwood,PaulaR;Given,BarbaraA;Given,CharlesW;Sikorskii,Alla;You,Mei;Prince,Jennifer
研究目的：缺乏对症状管理干预对增加家庭照顾者参与症状管理和照顾者情绪健康的影响进行评估的研究。此外，大多数护理人员干预措施是由医疗保健专业人员提供的，这在临床实践中实施起来可能成本高昂。本研究的目的是确定是否，在实体瘤患者中，护士提供的症状管理干预是更有效的比教练主导的干预措施，在增加照顾者参与症状管理和改善照顾者的情绪health.MethodsBoth照顾者和照顾者被招募的研究。患者的入选标准为年龄≥40岁、会说英语、认知功能完整，并诊断为III期或IV期肿瘤。二人组被随机分配到护士提供的症状管理干预（N= 88）与教练领导的组（N= 81）。通过电话采访收集数据，在基线，10，和16 weeks.ResultsThere没有显着的主要影响的问题解决干预症状援助在10周，但有两个显着的相互作用，试验臂和抑郁症状和基线之间的援助与症状和关系的病人。抑郁症状较轻的照顾者更有可能（OR = 1.99，95%CI = 1.45-2.76），以提供援助，在10周，如果他们接受护士提供的干预。在基线时提供帮助的配偶（与非配偶）照顾者在10周时提供帮助的可能性较小（OR = 0.58，95% CI 0.36-0.94）。没有显着的试验臂效应被发现照顾者的情绪健康，但援助与更多的症状与更严重的照顾者抑郁症状（p<0.01）和负担（对时间表的影响，p< 0.01）。数据还表明，仅关注护理对象症状管理的干预措施可能无法有效改善护理人员的情绪健康。
PurposeThere is a paucity of research evaluating the impact of symptom management interventions on increasing family caregiver involvement in symptom management and on caregivers' emotional health. In addition, most caregiver interventions are delivered by a health care professional, which can be costly to implement in clinical practice. The purpose of this study was to determine whether, in patients with solid tumors, a nurse-delivered symptom management intervention was more effective than a coach-led intervention in increasing caregiver involvement in symptom management and improving caregivers' emotional health.MethodsBoth caregivers and care recipients were recruited for the study. Inclusion criteria for patients were ≥40 years of age, English speaking, cognitively intact, and having a diagnosis of stage III or IV tumor. Dyads were randomized to a nurse-delivered symptom management intervention (N= 88) versus the coach-led group (N= 81). Data were collected via telephone interviews at baseline, 10, and 16 weeks.ResultsThere was no significant main effect of the problem-solving intervention on symptom assistance at 10 weeks, but there were two significant interactions, between trial arm and depressive symptoms and between baseline assistance with symptoms and relationship to the patient. Caregivers with lower depressive symptoms were more likely (OR = 1.99, 95% CI = 1.45–2.76) to provide assistance at 10 weeks if they received the nurse-delivered intervention. Spousal (versus non-spouses) caregivers who provided assistance at baseline were less likely to provide assistance at 10 weeks (OR = 0.58, 95% CI 0.36–0.94). No significant trial arm effects were found on caregiver emotional health, but assistance with greater number of symptoms was associated with worse caregiver depressive symptoms (p< 0.01) and burden (impact on schedule,p< 0.01).ConclusionsFindings suggest that a nurse-delivered problem-solving intervention increases family caregivers' level of assistance in symptom management for caregivers with lower levels of depressive symptoms. Data also suggest interventions focused solely on care recipient symptom management may not be effective in improving caregivers' emotional health.