Family Home Care for Cancer-Community Based Model

描述（申请人提供）：这一修订后的竞争性续期申请旨在确定家庭照顾者和患者之间的先进（III或IV期）疾病，正在接受一个疗程的化疗，并在过去7天内报告疼痛和疲劳，为期8周，6次接触解决问题，自我护理管理干预对症状数量，身体角色影响，社会功能和情绪困扰，与家庭照顾者和患者具有相同的纳入标准，但谁是暴露于注意力控制干预。PIMSS（Patient Intervention for Management of Symptoms and Support）帮助患者及其护理人员解决和管理三个问题领域：症状、功能（身体角色影响和社会功能）和情绪困扰。每个领域的问题通过4个干预主题解决：自我护理行为，与家人和提供者的沟通，信息教学，咨询和支持。循证干预策略和NCCN指南是从计算机辅助文档中选择的，这些文档允许护士个性化策略以实施并提高患者的自我效能，以便在干预后保留策略。指导患者与其家庭照顾者沟通，以帮助他们在家中实施干预措施，并对援助请求作出回应。试验两组的患者和护理人员接受相同数量的面对面和电话联系。两个小组都收到了工具包。注意力控制干预和工具包没有提供与症状、功能或痛苦相关的内容。因此，在实验组中提供的内容的效果可以单独与注意力分开。本研究将从三个癌症中心招募350名患者，流失率为30%，以保留最终分析所需的244例病例（每组122例）。计算把握度的主要结局是9周时的症状数量。这项研究仔细建立在当前RCT的证据基础上，该RCT支持化疗，分期以及疼痛和疲劳的存在对不良结局风险的影响。如果一个更短，更强烈的干预可以改善高风险患者的结果，这提供了基于理论的证据，行为干预对改善患者和家庭重要的结果的“增值”贡献。这将使这些干预措施成为临床实践的有力补充。

DESCRIPTION (provided by applicant): This revised competitive renewal application seeks to determine among family caregivers and patients with advanced (stages III or IV) disease who are undergoing a course of chemotherapy and who report both pain and fatigue during the past 7 days, the effect of an 8-week, 6-contact problem-solving, self care management intervention upon the number of symptoms, physical role impact, social function and emotional distress when compared with family caregivers and patients with identical inclusion criteria but who are exposed to an attention control intervention. The Patient Intervention for Management of Symptoms and Support (PIMSS) assists patients and their caregivers to address and manage three problem domains; symptoms, function (physical role impact and social function), and emotional distress. Problems in each domain are addressed through 4 intervention themes; self-care behaviors, communication with family and providers, information-teaching, and counseling and support. Evidenced-based intervention strategies and NCCN guidelines are selected from computer assisted documentation that allows nurses to individualize strategies for implementation and to enhance patient self-efficacy so that strategies are retained following the intervention. Patients are directed to communicate with their family caregivers to assist them to implement interventions at home and to respond to requests for assistance. Patients and caregivers in both arms of the trial receive the same number of in-person and telephone contacts. Both groups receive toolkits. The attention control intervention and toolkit provides no content related to symptoms, function or distress. Thus the effect of content provided in the experimental arm may be separated from attention alone. This research will accrue 350 patients from three cancer enters with an attrition rate of 30% to retain the needed 244 cases (122 per arm) for the final analyses. The primary outcome on which power is calculated is the number of symptoms at 9 weeks. This research builds carefully upon evidence from a current RCT which supports the impact of chemotherapy, stage, and presence of pain and fatigue upon the risk of poor outcomes. If a shorter, more intense intervention can improve the outcomes of patients at high risk, this provides theoretically based evidence of the "value added" contribution of behavioral interventions towards improving outcomes important to patients and families. That would make such interventions compelling additions to clinical practice.