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住院部转移到医院。 门诊诊所，让近 460 万家庭护理人员负责大部分日常护理 美国提供时钟癌症护理。癌症护理通常发生在情绪高度紧张的情况下 和社会环境，使护理人员容易受到重大的、可能持久的不利影响。 尽管姑息治疗团队处于理想的位置，可以帮助家庭护理人员应对众多 他们遇到的压力源，几乎没有证据可以作为门诊癌症护理人员支持的基础 姑息治疗诊所。为了满足在这种情况下对护理人员干预进行研究的迫切需要， 跨学科研究小组将针对问题解决疗法进行多中心、随机试验 正在接受门诊姑息治疗的癌症患者的家庭护理人员。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， 从而更好地了解最终将实施治疗的背景（如果显示出） 要有效果。该研究的具体目标如下：1）确定问题解决疗法对 接受门诊姑息治疗的癌症患者的家庭护理人员的心理困扰； 2） 衡量问题解决疗法对家庭照顾者积极照顾的影响 接受门诊姑息治疗的癌症患者； 3) 识别潜在的障碍和促进因素 在门诊姑息肿瘤学中对家庭护理人员采用问题解决疗法。结束时 在这项研究中，调查人员将广泛传播有关解决问题的有效性的调查结果 治疗，他们将能够通过日常和护理来促进家庭护理人员的福祉 在门诊姑息性癌症护理中持续提供问题解决疗法。

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.