Problem-Solving Therapy for Cancer Caregivers: A Randomized Clinical Trial in Outpatient Palliative Care

摘要 近几十年来，肿瘤治疗的主要场所已从医院的住院部转移到 门诊，留下近460万家庭照顾者负责大部分日常工作，全天候 时钟癌症护理在美国提供。癌症护理通常发生在压力很大的情绪中 和社会背景，使照料者容易受到重大的、可能长期的不利影响。 尽管姑息护理团队是帮助家庭照顾者应对众多 他们遇到的压力源，几乎没有证据表明癌症护理人员对门诊患者的支持 姑息治疗诊所。为了解决在这种情况下对照顾者干预研究的迫切需要， 跨学科的研究团队将进行一项多点、随机的问题解决疗法试验 接受门诊姑息治疗的癌症患者的家庭照顾者。潜在的障碍和 还将审查在农村和城市诊所采用解决问题疗法的促进者， 从而更好地了解治疗最终将在何种情况下交付 要有效率。本研究的具体目的如下：1)确定问题解决疗法对儿童心理健康的影响 门诊姑息治疗癌症患者家属照顾者心理困扰状况调查 测量问题解决疗法对儿童家庭照顾者照顾的积极方面的影响 接受门诊姑息治疗的癌症患者；以及3)找出潜在的障碍和促进者 姑息肿瘤科门诊家庭照顾者问题解决疗法的应用。在……结束时 在这项研究中，调查人员将广泛传播关于解决问题的有效性的研究结果 治疗，他们将处于有利地位，通过例行公事和 在门诊姑息治疗中持续提供解决问题的治疗。

ABSTRACT In recent decades, the primary setting for oncology treatment has shifted from the hospital inpatient unit to the outpatient clinic, leaving nearly 4.6 million family caregivers responsible for most of the day-to-day, round-the- clock cancer care provided in the United States. Cancer caregiving often occurs in a highly stressful emotional and social context, leaving caregivers vulnerable to significant, potentially long-lasting, adverse effects. Although palliative care teams are ideally positioned to help family caregivers cope with the numerous stressors they encounter, there is little evidence on which to base cancer caregiver support in the outpatient palliative care clinic. To address the pressing need for research on caregiver interventions in this setting, an interdisciplinary team of investigators will conduct a multisite, randomized trial of problem-solving therapy for family caregivers of individuals with cancer who are receiving outpatient palliative care. Potential barriers and facilitators to the adoption of problem-solving therapy in both rural and urban clinics will also be examined, resulting in a greater understanding of the context in which the therapy will ultimately be delivered if shown to be effective. The study’s specific aims are as follows: 1) determine the effect of problem-solving therapy on psychological distress among family caregivers of patients with cancer receiving outpatient palliative care; 2) measure the effect of problem-solving therapy on positive aspects of caregiving among family caregivers of patients with cancer receiving outpatient palliative care; and 3) identify potential barriers and facilitators to the adoption of problem-solving therapy for family caregivers in outpatient palliative oncology. At the conclusion of the study, investigators will broadly disseminate findings regarding the effectiveness of problem-solving therapy, and they will be well positioned to promote family caregiver wellbeing through the routine and sustained delivery of problem-solving therapy in outpatient palliative cancer care.