Caregivers of Cancer Pain Patients: Coping Intervention

癌痛患者的护理人员：应对干预

• 批准号: 6784170
• 负责人: SUSAN C MCMILLAN
• 金额: $ 35.01万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6784170
• 关键词: behavior therapy; behavioral /social science research tag; cancer pain; caregivers; clinical research; coping; dyadic interaction; emotional crisis; family nursing; home health care; human subject; human therapy evaluation; neoplasm /cancer palliative treatment; nursing intervention; nursing models; nursing research; pain; patient oriented research; quality of life; questionnaires; social support network; stress management

DESCRIPTION (provided by applicant): Three out of four families in the United States will have at least one family member diagnosed with cancer. In the majority of these families, one or more members will be responsible for providing care to the cancer patient. Up to 50- 80% of these patients will have significant pain, the majority not receiving adequate treatment. Important forces such as the movement out of the hospital created by diagnosis-related groups and the significant force of managed care have created a reality in which families and patients are finding themselves at home providing very complex care when that may not be their preference. The provision of this care is made more difficult by the presence of unrelieved pain. The reality is that the living room has become the intensive care unit and the place where family caregivers are exhausted and burdened. Family caregivers who have very little information about pharmacology, dosing of medications, and assessing or treating pain are asked to become around-the-clock care providers. Attention to caregiving issues is important in order to understand how this major, unpaid segment of our health care system works and what we can do to minimize the stress of caregiving. Research focusing on the family caregiver of the cancer patient with pain is limited. Much descriptive work has focused on the cancer patient with pain, with few outcome measures included for the caregiver. Most work suggests that caregivers have increased emotional distress. The impact of caregiving for cancer patients with pain on family members' quality of life (QOL) remains unclear since valid caregiver-specific QOL instruments have not been used. Another factor limiting research progress is the lack of an empirically validated conceptual model for understanding individual differences in QOL or improving QOL among caregivers of cancer patients with pain. The proposed program of research seeks to increase knowledge about caregiving for cancer patients with pain by using a valid, caregiver-specific QOL instrument and an empirically validated stress process model. Using the stress process model for caregiving, a psycho-education and coping skills intervention will be evaluated using a randomized, controlled design. Caregiver/patient dyads (n = 300) will be randomly assigned to standard care or standard care plus the coping skills intervention. The caregiver will attend six weekly one-hour visits containing didactic information regarding pain assessment, pain medications, side effects, recognition of emotional distress in the patient, stress management, and communication with the pain team, as well as role play scenarios around these themes. The effectiveness of the intervention will be tested as well as identification of potential mediators and moderators of the effectiveness of the intervention.

描述（由申请人提供）：美国四分之三的家庭中至少有一名家庭成员被诊断患有癌症。在大多数这样的家庭中，一个或多个成员将负责为癌症患者提供护理。高达50- 80%的患者会有明显的疼痛，大多数患者没有得到适当的治疗。一些重要的力量，例如由诊断相关团体造成的离开医院的运动，以及管理式护理的重要力量，已经造成了这样一个现实：家庭和患者发现自己在家提供非常复杂的护理，而这可能不是他们的偏好。由于存在无法缓解的疼痛，提供这种护理变得更加困难。现实是，客厅已经成为重症监护病房，成为家庭照顾者疲惫不堪、负担沉重的地方。对药理学、药物剂量、评估或治疗疼痛知之甚少的家庭照顾者被要求成为全天候的护理提供者。为了了解我们的医疗保健系统中这个主要的、无偿的部分是如何运作的，以及我们能做些什么来减少护理的压力，关注护理问题是很重要的。针对癌症疼痛患者的家庭照顾者的研究是有限的。许多描述性的工作都集中在患有疼痛的癌症患者身上，很少有针对护理人员的结果测量。大多数研究表明，照顾者增加了情绪困扰。由于没有使用有效的护理人员特异性生活质量工具，因此护理对疼痛癌症患者家庭成员生活质量（QOL）的影响尚不清楚。另一个限制研究进展的因素是缺乏经验验证的概念模型来理解生活质量的个体差异或改善癌症疼痛患者护理者的生活质量。提出的研究计划旨在通过使用有效的，护理者特异性的生活质量工具和经验验证的压力过程模型来增加对患有疼痛的癌症患者的护理知识。运用压力过程模型，采用随机对照设计对心理教育和应对技能干预进行评估。护理者/患者二组（n = 300）将被随机分配到标准护理组或标准护理加应对技能干预组。护理人员将参加六次每周一小时的访问，包括关于疼痛评估、疼痛药物、副作用、患者情绪困扰的识别、压力管理、与疼痛团队的沟通等教学信息，以及围绕这些主题的角色扮演场景。将测试干预的有效性，并确定干预有效性的潜在中介和调节者。