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，本计划项目的目标是：1。通过探索和干预改善配偶/伴侣照顾者的经验和结果，推进癌症临终和丧亲护理科学; 2.加快组建一个新的跨学科科学团队，由三个独立的研究项目组成，利用不同的视角来提高理解，并制定有意义的干预措施，解决临终关怀和丧亲关怀的连续性问题; 3.通过个人研究和现有的研究计划，将研究问题扩展到可能的范围之外; 4.为了加速和扩大有效的临终和丧亲模型、方法和研究结果的传播，将通过实施三个基于理论的研究项目来实现这些目标，这些项目共享一个实施核心，该核心提供项目之间的基础设施和协调。第一个项目，电话症状护理（SCP），一个前瞻性的临床试验，将测试一个自动化的计算机为基础的电信系统，评估严重程度和痛苦的身体和心理症状常见的生命结束时，发送电子邮件警报的临终关怀护士未缓解的症状，并提供定制的管理策略，配偶/伴侣照顾者的基础上，个人的症状模式。300名50岁以上的家庭临终关怀癌症患者及其护理人员将随机接受干预或常规护理。第二个项目，护士-护理人员沟通（NCC）将同时开始。它将研究在录音临终关怀RN家访期间与300名护理人员的沟通模式和沟通轨迹。这些相互作用将使用Roter相互作用分析系统进行编码。第三个项目，个性化的双重过程模型，将测试干预措施的有效性，以加强应对过程和结果的配偶/伴侣照顾者在丧亲之痛。将从SCP项目中随机选择160名失去亲人的照顾者，并将其分配到两个SCP项目组中的一个。其他协同、相互依存的目标将解决跨项目问题，并使用死亡前和死亡后数据扩展分析的深度和广度。

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.