Mechanical Circulatory Support in Patient-Caregiver Dyads: A Longitudinal Study

患者与护理人员二人组中的机械循环支持：一项纵向研究

• 批准号: 8648309
• 负责人: Julie Theresa Bidwell
• 金额: $ 3.93万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8648309
• 关键词: Address; Adult; Ambulatory Care; American; Anxiety; Cardiovascular Diseases; Caregivers; Caring; Characteristics; Clinical; Clinical Management; Clinical Research; Cohort Studies; Collaborations; Complex; Consensus; Data; Development; Dimensions; Disease; Disease-Free Survival; Enrollment; Ensure; Ethics; Event; Goals; Guidelines; Health; Heart Transplantation; Heart failure; Hostility; Individual; Intervention; Knowledge; Link; Literature; Longitudinal Studies; Mechanics; Mental Depression; Mental Health; Methods; Modeling; National Research Service Awards; Nurses; Outcome; Outpatients; Parents; Patients; Play; Population; Populations at Risk; Prevention; Provider; Quality of life; Relative (related person); Research; Research Personnel; Risk; Role; Scientist; Symptoms; Therapeutic; Time; Training; Vulnerable Populations; base; biobehavior; caregiving; clinically relevant; experience; high risk; implantation; improved; innovation; next generation; optimism; physical conditioning; premature; programs; prospective; psychologic; psychosocial; public health relevance; response; success; ventricular assist device

DESCRIPTION (provided by applicant): Heart failure (HF) is the fastest growing cardiovascular disorder in the U.S., and ventricular assist device (VAD) therapy is emerging as a main therapeutic option for advanced HF. Because outpatient care of a VAD patient is critical to the success of this high-risk therapy, current guidelines require that VAD patients designate an informal caregiver. At the same time, broad consensus in the literature that associates caregiving with compromised health and quality of life (QOL) suggests that VAD caregivers are also an at-risk population. Together, mandated patient-caregiver dyads play a critical role in VAD therapy, but without knowledge of the impact of VAD therapy on the dyad, providers are limited in their ability to identify and support patients and caregivers at greater risk for poor outcomes. As such, the overall goal of this proposed research is to provide much-needed quantitative data on VAD patient-caregiver dyads, describing changes in and identifying determinants of patient, caregiver, and dyadic outcomes over time. A prospective longitudinal cohort study, ancillary to a NINR-sponsored R01 on VAD patients, will be conducted to collect data on associated caregivers of patients enrolled in the parent study. Using a dyadic approach, multilevel and multivariate longitudinal modeling will be used to: 1) identify individual-level (patient and caregiver) determinants of worse patient clinical event risk and QOL, 2) quantify the relationship between individual-level determinants of worse caregiver strain and physical health, and 3) describe change in psychological symptoms and QOL in VAD patient-caregiver dyads over time. This innovative research will be the first longitudinal, quantitative study of patient-caregiver dyads in VAD, and will therefore provide foundational data to advance clinical management and research, and better support optimal patient, caregiver, and dyadic outcomes. Additionally, as part of a National Research Service Award proposal, this study contributes to the long-term goal of developing the applicant into an independent and productive nurse-scientist with a sustainable program of research that develops clinically relevant, actionable knowledge to address critical concepts and issues in the management and support of this rapidly growing, at-risk population of VAD patients and their caregivers. In order to ensure that the applicant has the necessary knowledge and expertise to attain this goal, this proposal draws on the combined expertise of an exemplary interdisciplinary team, consisting of expert clinicians and researchers in HF, VAD, and caregiving dyads, who have, in collaboration with the applicant, developed a comprehensive training plan that includes essential mastery of content and applied experience in the ethical conduct of research, multiple analytic approaches, and scholarly dissemination. The fundamental outcomes of this proposal are therefore well-aligned with the goals of the NINR, in that it will support the development the next generation of nurse scientists and enhance innovation, while concurrently providing information to promote health, improve QOL, and reduce symptoms in a growing and vulnerable population of patients and caregivers.

描述（由申请人提供）：心力衰竭（HF）是美国增长最快的心血管疾病，心室辅助装置（VAD）治疗正在成为晚期心力衰竭的主要治疗选择。由于VAD患者的门诊护理对这种高风险治疗的成功至关重要，目前的指南要求VAD患者指定一名非正式的护理人员。与此同时，文献中关于护理与健康和生活质量受损（QOL）相关的广泛共识表明，VAD护理人员也是高危人群。总之，强制性的患者-护理人员对VAD治疗起着至关重要的作用，但如果不了解VAD治疗对这对人的影响，提供者识别和支持患者和护理人员的能力就会受到限制，这些患者和护理人员面临更大的不良后果风险。因此，本研究的总体目标是提供急需的VAD患者-护理人员二元组的定量数据，描述患者、护理人员和二元组结果随时间的变化并确定其决定因素。将进行一项前瞻性纵向队列研究，作为nnr赞助的VAD患者R01的辅助研究，以收集参加父母研究的患者相关护理人员的数据。使用二元方法，将使用多水平和多变量纵向建模：1)确定患者临床事件风险和生活质量较差的个人水平（患者和护理人员）决定因素，2)量化护理人员压力较差的个人水平决定因素与身体健康之间的关系，以及3)描述VAD患者-护理人员二元组的心理症状和生活质量随时间的变化。这项创新研究将是第一次对VAD患者-护理人员的纵向定量研究，因此将为推进临床管理和研究提供基础数据，并更好地支持患者、护理人员和护理人员的最佳结果。此外，作为国家研究服务奖提案的一部分，该研究有助于将申请人培养成为一名独立和富有成效的护士科学家，具有可持续的研究计划，开发临床相关的，可操作的知识，以解决管理和支持快速增长的VAD患者及其护理人员的关键概念和问题。为了确保申请人具备实现这一目标所需的知识和专业技能，本提案借鉴了一个典型的跨学科团队的综合专业知识，该团队由HF， VAD和护理双方面的专家临床医生和研究人员组成，他们与申请人合作制定了一个全面的培训计划，其中包括对研究伦理行为的基本掌握和应用经验，多种分析方法，以及学术传播。因此，该提案的基本成果与国家护理研究中心的目标非常一致，因为它将支持下一代护士科学家的发展并加强创新，同时为日益增长的弱势患者和护理人员提供促进健康、改善生活质量和减轻症状的信息。