A Problem Solving Intervention for Hospice Caregivers

摘要 临终关怀的概念是为面临生命限制的人提供高质量的富有同情心的护理 疾病，包括临床护理，疼痛管理，情绪和精神 根据病人和家属的需要和喜好提供专门的支助。家庭成员，配偶， 朋友或其他人承担无偿或非正式的沟通角色，对传递信息至关重要 然而，压力和照顾者的负担会对照顾者的健康产生负面影响。 发病率和死亡率。在家中照顾临终者的个人的情感需要 没有得到很好的照顾，旨在为临终关怀护理人员提供支持的干预措施 明显缺乏。我们的团队最近完成了一项随机临床试验（Grant Nr. R 01 NR 012213）与514名临终关怀护理人员一起测试问题解决疗法（PST） 我们专门为临终关怀环境量身定制的干预，名为PISCES（问题解决 在临终关怀环境中支持护理人员的干预措施）。我们的研究结果表明， PISCES面对面干预是有效的， 与其他组相比，焦虑显著减少，生活质量提高 （视频组和注意力控制）。从我们的RCT研究中学到的另一个教训是， 护理人员不仅要关注具体问题或挑战， 的积极方面。人们发现，这种积极的重新评价方法 加强在其他环境中解决问题的干预措施。这次更新的具体目标是 应用程序是：1）比较PISCES干预的有效性时，交付面 在混合平台上交付时（第一次会议亲自参加， 会议通过视频）临终关怀护理人员; 2）比较PISCES的有效性 PISCESplus（PISCESplus）是一种整合了积极的 再评价要素; 3）评估照顾者对 PISCES plus干预;以及4）对三个干预组进行成本分析。

Abstract Hospice care is conceptualized as quality compassionate care for people facing a life-limiting illness, with services that cover clinical care, pain management, and emotional and spiritual support tailored to patients' and families' needs and preferences. Family members, spouses, friends or others who assume the unpaid or informal caregiving role are essential to the delivery of hospice services; however, stress and caregiver burden can negatively affect caregivers' morbidity and mortality. The emotional needs of individuals caring for dying persons at home are not well attended, and interventions aiming to provide support to hospice caregivers are notably lacking. Our team recently completed a randomized clinical trial (Grant Nr. R01NR012213) with 514 hospice caregivers to test a problem-solving therapy (PST) intervention we tailored specifically for the hospice setting, entitled PISCES (Problem-solving Intervention to Support Caregivers in End of Life care Settings). Our findings demonstrate that the PISCES intervention when delivered face to face was effective leading to statistically significant decrease in anxiety and increase in quality of life when compared to the other groups (video group and attention control). An additional lesson learned from our RCT study is that caregivers wanted to focus not only on specific problems or challenges, but also on recognizing the positive aspects of caregiving. This approach of positive reappraisal has been found to enhance problem solving interventions in other settings. The specific aims of this renewal application are: 1) to compare the effectiveness of the PISCES intervention when delivered face to face and when delivered in a hybrid platform (with the first session in person and remaining sessions via video) to hospice caregivers; 2) to compare the effectiveness of the PISCES intervention to the refined PISCES intervention (PISCESplus) that integrates positive reappraisal elements; 3) to assess caregivers' perceptions of and satisfaction with the PISCESplus intervention; and 4) to conduct a cost analysis of the three intervention groups.