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，并响应支持征求解决疼痛管理建议的另外11个机构(PA-07-282)，本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护理人员对疼痛管理的看法，从而改善面临绝症患者的疼痛控制。经过令人鼓舞的试验性测试，干预被命名为积极的(通过视频会议评估照顾者的团队干预)。该项目建议通过使用商业视频技术，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最终测试护理者/患者参与临终关怀跨学科团队会议对护理者对疼痛的感知的影响，以及感知的变化对报告的患者疼痛的影响。这项研究的目的是1)测试主动干预的有效性，特别是关注护理者对疼痛感知的变化，护理者评估的有效性，以确定谁将从主动干预中获得最大好处，以及患者报告的疼痛程度感知变化的影响，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。Saltz和Schaefer修正的理论模型主张将对组织背景、团队过程、团队结构和结果的评估作为干预的基础。这项建议将544名临终关怀者随机分为两组(标准护理和干预)，并使用并行和平等地位的定性和定量方法。定性设计包括对团队会议的观察、记录审查以及与员工和家人的访谈。量化部分使用标准化工具来衡量参与的结果。如果成功，主动干预可以很容易地转化为其他环境，具有改善所有慢性和终末期疼痛的疼痛管理的潜力。

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.