Caregiver-Guided Pain Management Training in Palliative Care

姑息治疗中护理人员指导的疼痛管理培训

• 批准号: 8825552
• 负责人: Francis J. Keefe
• 金额: $ 62.07万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-26 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8825552
• 关键词: Aftercare; Back; Behavioral; Bereavement; Cancer Patient; Caregivers; Caring; Cessation of life; Coping Skills; Distress; Educational Intervention; Educational Materials; Educational process of instructing; Ensure; Family; Family Caregiver; Family member; Goals; Guided imagery; Health; Healthcare; Hour; Imagery; Intervention; Lead; Malignant Neoplasms; Methods; Outcome; Pain; Pain management; Pain quality; Palliative Care; Patients; Pilot Projects; Protocols documentation; Quality of life; Randomized; Relaxation; Reporting; Research; Research Design; Research Priority; Resources; Sample Size; Sampling; Self Efficacy; Severities; Site; Techniques; Testing; Training; Training Programs; Videoconferences; Videoconferencing; cancer pain; caregiving; coping; efficacy testing; end of life; experience; follow-up; hospice environment; improved; loved ones; meetings; member; novel; psychologic; psychological distress; psychosocial; public health relevance; satisfaction; symptom management; therapy design; treatment as usual; trend

DESCRIPTION (provided by applicant): Pain at the end of life is a major concern of cancer patients and their family caregivers. The focus of pain management efforts for cancer pain traditionally has been on the patient. Studies of family members, however, have documented that the psychosocial impact of end of life care is profound, particularly when the patient is experiencing pain. For family caregivers, this impact endures--often resulting in increased psychological distress and poorer health long after their loved one dies. The ultimate goal of this research is to develop more effective ways to help patients and their family caregivers cope with cancer pain and thereby reduce the psychological distress associated with pain for the patient and the short-term and enduring negative effects of the caregiving experience for their family members. We recently completed a small pilot study to test a novel Caregiver-Guided Pain Management Training protocol that trained hospice-eligible patients with cancer pain and their family caregivers in behavioral pain coping skills (e.g., relaxation, guided imagery, activity pacing) and taught them how to apply coping skills to manage negative pain-related sequelae and enhance their quality of life. Results indicated that the intervention led to significant improvements in caregiver self-efficacy for helping patients manage pain, and trends for improvements in caregiver strain and patient pain. The proposed study builds on and extends these findings by (a) utilizing the resources and support of the PCRC to access a larger and more diverse sample of patients and their informal caregivers; (b) delivering the intervention via videoconference to increase access and potential for dissemination; and (c) assessing the impact of the intervention on caregiver adjustment after the patient's death. To our knowledge, this will be the first RCT to rigorously examine whether a pain coping skills intervention designed to improve the caregiver's ability to help the patient manage pain at end of life can lead to caregiver benefits during the bereavement period. In this multi-site study, 236 dyads (patients and their family caregivers) will be randomized to either the Caregiver-Guided Pain Management Training protocol or to an Enhanced Treatment-as-Usual control condition. Dyads in the Caregiver-Guided Pain Management condition will receive three one-hour sessions conducted via videoconference. Dyads in the Enhanced Treatment-as-Usual condition will receive educational material about cancer pain and its management but will not receive any study-related treatment sessions. Assessments will be conducted with patients and caregivers before and after treatment, and with caregivers 3 months and 6 months following the patient's death. The primary hypothesis to be tested is that caregivers who receive the intervention will report significantly higher levels of self-efficacy for helping the patient manage pain than caregivers in the control condition. Secondary aims will focus on (a) improvements in short-term caregiver adjustment as well as caregiver adjustment following the patient's death, and (b) patient pain severity, self-efficacy for pain management, and psychological distress.

描述（由申请人提供）：临终时的疼痛是癌症患者及其家庭护理人员的主要关注点。传统上，癌症疼痛的疼痛管理工作的重点是患者。然而，对家庭成员的研究表明，临终关怀的心理社会影响是深远的，特别是当患者经历痛苦时。对于家庭照顾者来说，这种影响会持续存在——通常会导致他们的亲人去世后很长时间内心理困扰加剧，健康状况恶化。此次活动的最终目的 研究的目的是开发更有效的方法来帮助患者及其家人护理人员应对癌症疼痛，从而减少患者与疼痛相关的心理困扰以及护理经历对其家人造成的短期和持久的负面影响。我们最近完成了一项小型试点研究，以测试一种新颖的护理人员引导疼痛管理培训方案，该方案对符合临终关怀资格的癌症疼痛患者及其家庭护理人员进行行为疼痛应对技能（例如放松、引导想象、活动节奏）的培训，并教会他们如何应用应对技能来管理与疼痛相关的负面后遗症并提高他们的生活质量。结果表明，干预措施显着提高了护理人员帮助患者控制疼痛的自我效能，以及护理人员压力和患者疼痛改善的趋势。拟议的研究基于并扩展了这些发现，方法是：(a) 利用 PCRC 的资源和支持来获取更大、更多样化的患者及其非正式护理人员样本； (b) 通过视频会议进行干预，以增加传播的机会和潜力； (c) 评估患者死亡后干预措施对护理人员调整的影响。据我们所知，这将是第一个随机对照试验，严格检验旨在提高护理人员帮助患者管理临终疼痛的能力的疼痛应对技能干预措施是否可以为护理人员在丧亲期间带来好处。在这项多中心研究中，236 名双人组（患者及其家庭护理人员）将被随机分配接受护理人员指导的疼痛管理培训方案或增强的常规治疗控制条件组。处于护理人员指导疼痛管理条件下的二人将接受通过视频会议进行的三场各一小时的会议。处于加强照常治疗状态的二人将收到有关癌症疼痛及其管理的教育材料，但不会接受任何与研究相关的治疗课程。将在治疗前和治疗后对患者和护理人员进行评估，并在患者死亡后 3 个月和 6 个月对护理人员进行评估。要测试的主要假设是，接受干预的护理人员在帮助患者控制疼痛方面的自我效能感明显高于对照组的护理人员。次要目标将集中于（a）改善短期护理人员的调整以及患者死亡后护理人员的调整，以及（b）患者疼痛的严重程度、疼痛管理的自我效能和心理困扰。