Building Family Caregiver Skills Using a Simulation-Based Intervention for Care of Patients with Cancer

项目摘要/摘要： 头颈部、肺癌、食道癌、直肠癌和肛门癌的患者通常要经历严格的，激烈的， 综合治疗(放射、手术和/或化疗)，并经历高症状负担， 功能障碍和复杂的心理社会问题。积极的治疗结果和避免 并发症在很大程度上取决于家庭成员提供的护理是否充分。然而，家庭 照顾者(CG)报告说，他们感觉没有准备好承担多重、复杂的照看任务，包括 在气管造口护理、导管喂养、伤口和结肠造口护理、疼痛管理以及 持续的情感支持。尽管是肿瘤保健团队的关键扩展，但CGs的培训 管理症状，处理与护理对象的沟通问题，并照顾自己的身体 和情绪健康，没有融入到临床实践中。这项研究将衡量一项 结合结构化模拟或经验的心理教育和技能培训干预 学习改善CG、患者和医疗保健利用结果。模拟在训练中是有效的 医疗保健专业人员，但对其在培训家庭CG方面的有效性知之甚少。干预措施是 专为癌症活跃期和治疗后存活期的即时过渡而设计 CG和患者最脆弱的时间。这两组人的具体目标，前瞻性，随机化 对照试验是：(1)与对照组相比，评估CG干预对CG的影响 初级(焦虑)和次级(抑郁、与健康相关的生活质量[HRQOL]和疲劳)结果；(2) 测量干预对患者预后的影响(HRQOL和中断的疗程)和 医疗保健利用结果(计划外入院、计划外急诊室就诊和 意外使用静脉输液)；(3)确定CG自我效能是否在干预效果中起中介作用 (4)确定患者的疾病因素、护理需求、患者和CG的人口统计因素 协调干预和CG结果之间的关系；(5)比较医疗成本 干预组和对照组之间的利用情况。我们将从大学医院招聘180名CG 凯斯综合癌症中心的塞德曼癌症中心。干预涉及三个面对面的人， 在放射治疗期间进行一对一的治疗，然后在治疗后两周进行电话联系。数据 将在基线、放射治疗结束时以及放射治疗后4周和20周收集。 分析将包括线性混合模型重复测量、中介和调节测试，以及 泊松回归方法。拟议的项目涉及国家癌症研究所的癌症部门 控制和人口科学使命：改善对个人和家庭成员的护理 受癌症影响。研究结果将为翻译心理教育和 本次干预采用模拟方法对其他CG人群和临床环境进行干预。

Project Summary/Abstract: Patients with head and neck, lung, esophageal, rectal, and anal cancers typically undergo rigorous, intense, combined-modality treatment (radiation, surgery, and/or chemotherapy) and experience high symptom burden, functional impairment, and complex psychosocial issues. Positive treatment outcomes and avoidance of complications are dependent largely on the adequacy of care provided by family members. However, family caregivers (CGs) report feeling unprepared to assume the multiple, complex tasks of caregiving, including tangible help with tracheostomy care, tube feedings, wound and colostomy care, pain management, and ongoing emotional support. Despite being a critical extension of the oncology healthcare team, training of CGs to manage symptoms, deal with communication issues with care recipients, and take care of their own physical and emotional health, is not integrated into clinical practice. This study will measure the effect of a psychoeducational and skills training intervention that incorporates structured simulation or experiential learning to improve CG, patient, and healthcare utilization outcomes. Simulation is effective in training healthcare professionals, but little is known about its effectiveness in training family CGs. The intervention is designed for the period of active cancer treatment and the immediate transition to posttreatment survivorship, a time when the CG and patient are most vulnerable. The specific aims of this 2-group, prospective, randomized controlled trial are to: (1) evaluate the effect of a CG intervention, as compared to a control group, on CG primary (anxiety) and secondary (depression, health-related quality of life [HRQOL], and fatigue) outcomes; (2) measure the effect of the intervention on patient outcomes (HRQOL and interrupted treatment course) and healthcare utilization outcomes (unplanned hospital admission, unplanned emergency room visits, and unplanned use of intravenous fluids); (3) determine if CG self-efficacy mediates the effect of the intervention on CG anxiety; (4) determine if patient illness factors, care demands, and patient and CG demographic factors moderate the relationship between the intervention and CG outcomes; and (5) compare the costs of healthcare utilization between the intervention and control groups. We will recruit 180 CGs from University Hospitals Seidman Cancer Center at the Case Comprehensive Cancer Center. The intervention involves three in-person, one-on-one sessions during radiation treatments, followed by a telephone contact 2 weeks posttreatment. Data will be collected at baseline, at the end of radiation treatment, and 4 and 20 weeks postradiation treatment. The analysis will consist of linear mixed model repeated measures, mediation and moderation tests, and Poisson regression methods. The proposed project addresses National Cancer Institute's Division of Cancer Control and Population Sciences mission of improving the delivery of care to individuals and family members affected by cancer. The study findings will provide crucial information for translating the psychoeducational and simulation methods used in this intervention to other CG populations and clinical settings.