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

摘要 近几十年来，肿瘤治疗的主要环境已从医院住院部转移到 门诊诊所，留下近460万家庭护理人员负责大部分的日常， 在美国提供的时钟癌症护理。癌症的发生往往是在高度紧张的情绪 和社会背景，使照顾者容易受到重大的，可能是长期的，不利的影响。 虽然姑息治疗团队的理想定位，以帮助家庭照顾者科普众多的 虽然他们遇到的压力源，但几乎没有证据可以作为门诊癌症护理人员支持的基础。 姑息治疗诊所为了解决在这种情况下对护理人员干预措施进行研究的迫切需要， 一个跨学科的研究小组将进行一项多地点的随机试验，研究解决问题的治疗方法， 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 还将审查农村和城市诊所采用解决问题疗法的促进者， 从而更好地理解治疗最终将被递送的背景， 要有效率。本研究的具体目的如下：1）确定问题解决疗法对 癌症患者接受门诊姑息治疗的家庭照顾者的心理困扰; 测量问题解决疗法对家庭照顾者的积极方面的影响， 接受门诊姑息治疗的癌症患者;以及3）确定潜在的障碍和促进因素， 在门诊姑息肿瘤治疗中对家庭照顾者采用解决问题的疗法。结束时 在这项研究中，研究人员将广泛传播关于解决问题的有效性的研究结果， 治疗，他们将很好地定位，以促进家庭照顾者的福祉，通过例行和 在门诊姑息性癌症护理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.