The ACTIVE Intervention to Improve Hospice Caregiver Pain Management

描述（由申请人提供）：与NINR促进和改善个人、家庭、社区和人口健康的使命一致，并响应另外11个支持征集解决疼痛管理提案的机构（PA-07-282），本提案旨在测试一种干预措施，该干预措施将提高临终关怀患者护理人员对疼痛管理的认识，从而改善那些面临绝症的人的疼痛控制。经过令人鼓舞的试点测试，该干预措施被命名为ACTIVE（通过视频接触评估团队干预的护理人员）。本计划建议透过商用视频技术，让病人/家属参与到跨学科的安宁疗护团队中，以加强对病人的安宁疗护。本随机对照试验将明确检验疗护者/病人参与安宁疗护跨学科团队会议对疗护者疼痛感知的影响，以及感知变化对病人报告疼痛的影响。本研究旨在1)检验ACTIVE干预的有效性，特别关注照顾者对疼痛感知的改变，照顾者评估的有效性，以确定最能从ACTIVE干预中获益的个体，以及感知变化对患者报告的疼痛严重程度的影响，2)评估成本和收益，3)评估ACTIVE干预转化为常规安宁疗护的潜力。Saltz和Schaefer修改的理论模型主张对组织背景、团队过程、团队结构和结果的评估作为干预的基础。本研究将544名临终关怀照护者随机分为标准照护组和干预组，采用平行、平等的定性与定量方法。定性设计包括对团队会议的观察、记录审查以及对员工和家庭成员的采访。定量部分使用标准化的工具来衡量参与的结果。如果成功，积极干预可以很容易地转化到其他环境中，有可能改善所有慢性和晚期疼痛的疼痛管理。

DESCRIPTION (provided by applicant): In congruence with the mission of NINR to promote and improve the health of individuals, families, communities, and populations and in response to the 11 additional institutes supporting the solicitation of proposals to address pain management (PA-07-282) this proposal seeks to test an intervention which will improve the perceptions of pain management by caregivers of hospice patients, resulting in improved pain control for those facing terminal illness. Following encouraging pilot testing the intervention has been named ACTIVE (Assessing Caregivers for Team Intervention through Video Encounters). This project proposes to strengthen hospice care for patients by enabling patient/family participation in hospice interdisciplinary teams through use of a commercially available video technologies. This randomized controlled trial will definitively test the effect of caregiver/patient participation in hospice interdisciplinary team meetings on the caregiver's perception of pain and the effect of changes in perception on reported patient pain. The study aims to 1) test the effectiveness of the ACTIVE intervention, specifically focusing on the changes in caregiver perceptions of pain, the effectiveness of caregiver assessment to identify individuals who will most benefit from the ACTIVE intervention, and the effect of changes in perception on severity of pain reported by the patient, 2) evaluate the cost and benefits and, 3) evaluate the potential for translation of the ACTIVE intervention into routine hospice care. The theoretical model modified from Saltz and Schaefer advocate the assessment of the organizational context, team process, team structure, and outcomes as a foundation for the intervention. This proposal randomizes 544 hospice caregivers into two groups (standard care and intervention) and uses qualitative and quantitative methods in parallel and equal status. The qualitative design includes observations of team meetings, record reviews, and interviews with staff and family members. The quantitative component uses standardized instruments to measure the outcomes of participation. If successful, the ACTIVE intervention can be easily translated into other settings, holding potential to improve pain management for all suffering chronic and terminal pain.