The ACTIVE Intervention to Improve Hospice Caregiver Pain Management

描述（申请人提供）：与NINR的使命一致，即促进和改善个人、家庭、社区和人群的健康，并响应11个额外的研究所支持征求解决疼痛管理的建议（PA-07-282）该提案旨在测试一种干预措施，该干预措施将改善临终关怀患者的护理人员对疼痛管理的看法，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，干预措施已被命名为ACTIVE（通过视频会议评估护理人员进行团队干预）。该项目建议通过使用商业上可用的视频技术，使患者/家庭能够参与临终关怀跨学科团队，从而加强对患者的临终关怀。这项随机对照试验将明确测试护理人员/患者参与临终关怀跨学科团队会议对护理人员疼痛感知的影响，以及感知变化对报告的患者疼痛的影响。该研究旨在1）测试ACTIVE干预的有效性，特别关注护理人员对疼痛的感知变化，护理人员评估的有效性，以确定最能从ACTIVE干预中受益的个体，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）评估将主动干预转化为常规临终关怀的可能性。从Saltz和Schaefer修改的理论模型主张评估的组织背景，团队过程，团队结构和成果作为干预的基础。本研究将544位安宁照护者随机分为标准照护与介入照护两组，并以质性与量性研究方法进行平行、平等的研究。定性设计包括观察团队会议、记录审查以及与员工和家庭成员的访谈。数量部分使用标准化工具衡量参与的成果。如果成功，ACTIVE干预可以很容易地转化为其他环境，从而有可能改善所有慢性和晚期疼痛患者的疼痛管理。

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.