Caregiver-Guided Pain Management Training in Palliative Care

描述（由申请人提供）：生命末期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一直是患者。然而，对家庭成员的研究表明，临终关怀的社会心理影响是深远的，特别是当病人正在经历痛苦时。对于家庭照顾者来说，这种影响会持续下去-往往导致在他们所爱的人去世很久之后，心理压力增加，健康状况恶化。这个项目的最终目标 研究的目的是开发更有效的方法来帮助患者及其家庭护理人员科普癌症疼痛，从而减少患者因疼痛而产生的心理压力，以及癌症经历对其家庭成员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，以测试一种新的护理人员指导的疼痛管理培训方案，该方案培训了符合条件的癌症疼痛患者及其家庭护理人员的行为疼痛应对技能（例如，放松，引导图像，活动起搏），并教他们如何应用应对技能来管理负面疼痛相关的后遗症，提高他们的生活质量。结果表明，干预导致照顾者自我效能的显着改善，帮助患者管理疼痛，并改善照顾者的压力和患者疼痛的趋势。拟议的研究建立在这些调查结果的基础上，并通过以下方式扩展这些调查结果：（a）利用PCRC的资源和支持，访问更大和更多样化的患者及其非正式护理人员样本;（B）通过视频会议提供干预措施，以增加访问和传播潜力;（c）评估干预措施对患者死亡后护理人员调整的影响。据我们所知，这将是第一个RCT，以严格审查是否疼痛应对技能干预，旨在提高照顾者的能力，帮助病人管理疼痛在生命的尽头可以导致照顾者的好处在丧亲期间。在这项多中心研究中，236对患者（患者及其家庭护理人员）将被随机分配至护理人员指导的疼痛管理培训方案或增强的治疗作为家庭对照条件。在护理人员指导的疼痛管理条件下，将通过视频会议进行三次一小时的会议。处于强化治疗即治疗状态的双胞胎将接受有关癌痛及其管理的教育材料，但不会接受任何研究相关治疗。将在治疗前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。待检验的主要假设是，接受干预的护理人员将报告显着更高水平的自我效能，帮助患者管理疼痛比护理人员在控制条件。次要目标将集中在（a）短期护理人员调整以及患者死亡后护理人员调整的改善，和（B）患者疼痛严重程度、疼痛管理的自我效能和心理困扰。

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.