A Multimedia Self-Management Intervention to Prepare Family Caregivers and Patients for Lung Cancer Surgery

项目摘要-本提案的总体目的是测试多媒体自我测试的有效性 管理层(MSM)干预，为肺癌手术准备160名照顾者-患者二人组。这 研究是至关重要的，因为肺癌患者手术后出院时间更早，尽管 老年人口(65岁及以上)患有更多的共病和生活质量下降 (QOL)。因此，手术后的大部分护理负担落在了家庭照顾者(FCGS)身上。这 随机试验旨在整合护理、FCG研究和胸部外科领域，以便 开发一种可成为癌症手术标准护理的二元护理模式。此多个PD/PI Proposal利用了两个PI的临床和研究专业知识(Sun：护理、FCG研究；Kim： 手术)通过测试MSM干预来影响关键的FCG和影响其质量的患者变量 肺癌手术后的生活和护理质量。基于慢性病护理的自我管理模式 (CCM)，MSM干预是一种护士主导、以照顾者为基础的多媒体护理模式，适用于肺癌手术。 它的主要重点是1)为肺癌FCGS提供一对一的术后护理指导和 管理他们的生活质量需求；以及2)针对FCG患者在准备手术时的二元知识和技能 和术后恢复活动。干预包括视频、手册和事后的护士电话 出院。它在五个时间点给药：手术前、住院期间和3次。 出院后(第2天、第7天和2个月)积分。我们将测试MSM干预的效果 注意力控制组与干预组的随机试验，以追求以下特定目标： 具体目标1：测试MSM干预对FCG结局和癌症支持服务使用的影响； 具体目标2：测试MSM干预对患者结局和医疗资源利用的影响； 具体目标3：测试MSM干预对结果中介变量(激活性、自我效能感、 知识)；探索性目标1：探索主持人(年龄、性别、婚姻状况、照顾者关系) 患者、照顾者就业状况、FCG与患者结局的共病以及相互关系 关系；探索性目标2：通过离职访谈，确定参与者与男男性接触者的经历 干预。这一建议是创新的，因为它融合了癌症护理的科学，自我 加强胸科手术管理，提高对癌症手术患者的护理水平。这项建议是 重要的是因为正在研究的结果被引用为对 FCGS、患者、外科医生、国家癌症研究所和医学研究所；这些成果包括 心理困扰、照顾者负担、生活质量和医疗资源使用。长期目标是 证明CCM可以应用于肺癌患者和他们的FCGS，以更好地为他们做好准备 手术，改善术后结果，并优化医疗资源/癌症支持服务的使用。

Project Summary - The overall purpose of this proposal is to test the efficacy of a Multimedia Self- Management (MSM) Intervention to prepare 160 caregiver-patient dyads for lung cancer surgery. This research is critical because lung cancer patients are discharged from the hospital earlier after surgery despite an aging population (age 65 and older) that suffers from greater co-morbidities and decreased quality of life (QOL). As a result, the bulk of the caregiving burden after surgery has fallen on family caregivers (FCGs). This randomized trial is designed to integrate the fields of nursing, FCG research and thoracic surgery in order to develop a dyadic model of care that can become a standard of care in cancer surgery. This multiple PD/PI proposal leverages the clinical and research expertise of the two PIs (Sun: nursing, FCG research; Kim: surgery) by testing the MSM Intervention to impact key FCG and patient variables that influence their quality of life and the quality of care after lung cancer surgery. Based on the Chronic Care Self-Management Model (CCM), the MSM Intervention is a nurse-led, caregiver-based, multimedia care model for lung cancer surgery. Its primary focus is 1) to provide one-on-one coaching with lung cancer FCGs on post-operative caregiving and managing their QOL needs; and 2) to target FCG-patient dyadic knowledge and skills in preparing for surgery and post-operative recovery activities. The intervention includes video, handbook, and nurse phone calls after hospital discharge. It is administered at five time points: before surgery, during hospitalization, and at 3 time points (day 2, day 7, and 2 months) after discharge. We will test the efficacy of the MSM Intervention using a randomized trial of attention control group versus an intervention group to pursue the following specific aims: Specific Aim 1: Test the effects of the MSM Intervention on FCG outcomes and cancer support services use; Specific Aim 2: Test the effects of the MSM Intervention on patient outcomes and healthcare resource use; Specific Aim 3: Test the effects of the MSM Intervention on outcome mediators (activation, self-efficacy, knowledge); Exploratory Aim 1: Explore moderators (age, sex, marital status, caregiver relationship to patient, caregiver employment status, co-morbidities) of FCG and patient outcomes and reciprocal relationships; Exploratory Aim 2: Determine, through exit interviews, participant's experience with the MSM intervention. This proposal is innovative because it merges the science of cancer caregiving, self- management, and thoracic surgery in order to improve the care of cancer surgery patients. This proposal is significant because the outcomes which are being studied have been cited to be of critical importance to FCGs, patients, surgeons, the National Cancer Institute, and the Institute of Medicine; these outcomes include psychological distress, caregiver burden, quality of life, and healthcare resource use. The long-term goal is to prove that the CCM can be applied to patients with lung cancer and their FCGs to better prepare them for surgery, improve postoperative outcomes, and optimize healthcare resource/cancer support services use.