Enhancing End-of-Life and Bereavement Outcomes Among Cancer Caregivers

项目总结(见说明)： 结合三个跨学科研究团队的优势，该计划项目的目标是：1.通过探索和干预来促进癌症临终关怀和丧亲护理的科学，以改善配偶/伴侣照顾者的体验和结果；2.从三个不同的研究项目加快形成一个新的跨学科科学团队，利用不同的视角来提高理解，并产生有意义的干预措施，解决临终关怀和丧亲护理的连续体；3.扩展研究问题，超越通过个人研究和现有研究计划可能提出的问题；4.为加速和扩大传播有效的临终和丧亲模式、方法和结果，将通过实施三个具有理论基础的研究项目来实现这些目标，这些研究项目共享一个执行核心，为各项目之间提供基础设施和协调。第一个项目是电话症状护理(SCP)，这是一项前瞻性的临床试验，将测试基于计算机的自动化电信系统，该系统评估临终前常见的身体和心理症状的严重性和痛苦，向临终关怀护士发送未缓解症状的电子邮件警报，并根据个别症状模式向配偶/伴侣照顾者提供量身定制的管理策略。300名50岁的家庭临终关怀癌症患者和他们的照顾者将被随机分配到干预或常规护理中。第二个项目，护士-护理员沟通(NCC)将同时开始。它将检查与300名照顾者进行临终关怀RN家访期间的沟通模式和沟通轨迹。这些互动将用Roter互动分析系统进行编码。第三个项目，个性化双进程模式(DPM)，将测试干预措施的有效性，以加强配偶/伴侣照顾者在丧亲期间的应对过程和结果。SCP项目中失去亲人的160名护理员将被随机挑选并分配到两个DPM项目组中的一个。其他协同、相互依赖的目标将解决跨项目问题，并利用死亡前和死亡后的数据扩大分析的深度和广度。

PROJECT SUMMARY (See Instructions): Combining the strengths of three interdisciplinary research teams, the goals of this program project are: 1. to advance the science of cancer end-of-life and bereavement care by exploring and intervening to improve the experience and outcomes for spouse/partner caregivers; 2. to expedite the formation of a new interdisciplinary science team from three separate programs of research, leveraging different perspectives to improve understanding and produce meaningful interventions that address the continuum of end-of-life and bereavement care; 3. to extend research questions beyond those possible through individual studies and existing research programs and; 4. to accelerate and expand the dissemination of effective end-of-life and bereavement models, methods and findings, The goals will be accomplished through implementation of three theoretically based research projects sharing one implementation core which provides the infrastructure and coordination among the projects. The first project, Symptom Care by Phone (SCP), a prospective clinical trial, will test an automated computer based telecommunication system that assesses severity and distress from physical and psychological symptoms common at the end-of-life, sends e-mail alerts to the hospice nurse of unrelieved symptoms and provides tailored management strategies to spouse/partner caregivers based on the individual symptom pattern. 300 home hospice cancer patients age 50+ and their caregivers will be randomized to intervention or usual care. The second project, Nurse-Caregiver Communication (NCC) will begin simultaneously. It will examine communication patterns and trajectories of communication during audio taped hospice RN home visits with the 300 caregivers. These interactions will be coded with the Roter Interaction Analysis System. The third project, Individualized Dual Process Model (DPM), will test the effectiveness of an intervention to enhance coping processes and outcomes of the spouse/partner caregivers during bereavement. 160 bereaved caregivers from the SCP project will be randomly selected and assigned to one of the two DPM project groups. Additional synergistic, interdependent aims will address cross project questions and extend the depth and breadth of the analyses using both pre and post death data.