Family Home Care for Cancer-Community Based Model

描述（由申请人提供）：本修订后的竞争性更新申请旨在确定家庭护理人员和晚期（III期或IV期）疾病患者，他们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，8周，6次接触解决问题，自我护理管理干预对症状数量的影响，身体角色的影响，社会功能和情绪困扰，与家庭照顾者和患者的纳入标准相同，但暴露于注意控制干预。患者干预管理症状和支持（PIMSS）帮助患者和他们的护理人员解决和管理三个问题域；症状、功能（身体角色影响和社会功能）和情绪困扰。通过4个干预主题解决每个领域的问题；自我照顾行为，与家人和提供者的沟通，信息教学，咨询和支持。基于证据的干预策略和NCCN指南是从计算机辅助文件中选择的，这些文件允许护士制定个性化的实施策略，并提高患者的自我效能感，以便在干预后保留策略。指导患者与其家庭护理人员进行沟通，以帮助他们在家中实施干预措施并回应援助请求。在试验的两组中，患者和护理人员接受了相同数量的面对面和电话联系。两组都收到了工具包。注意控制干预和工具包不提供与症状、功能或痛苦相关的内容。因此，实验臂中提供的内容的影响可以与注意力单独分开。该研究将从三个癌症中心收集350名患者，损耗率为30%，以保留所需的244例（每组122例）用于最终分析。计算疗效的主要结果是9周时症状的数量。本研究基于当前一项随机对照试验的证据，该试验支持化疗、分期、疼痛和疲劳对不良预后风险的影响。如果一个更短、更强烈的干预可以改善高危患者的结果，这就为行为干预在改善对患者和家庭重要的结果方面的“增值”贡献提供了理论上的证据。这将使这种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.