A Psychosocial Intervention for the Caregivers of Advanced Lung Cancer Patients

针对晚期肺癌患者护理人员的心理社会干预

基本信息

批准号：
9326815
负责人：
Hoda J Badr
金额：
$ 45.65万
依托单位：
BAYLOR COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-01 至 2019-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9326815
关键词：
Address Advance Directives Advanced Malignant Neoplasm Advocate Age Analgesics Anxiety Baseline Surveys Behavior Cancer Etiology Cancer Family Cancer Intervention Cancer Patient Caregiver Burden Caregiver support Caregivers Caring Clinical Practice Guideline Communication Comorbidity Competence Complement Complex Counseling Data Diagnosis Disease Documentation Education Educational process of instructing Emotional Enrollment Family Family Caregiver Family member Future Gender Home environment Individual Intervention Intervention Trial Malignant Neoplasms Malignant neoplasm of lung Manuals Mediating Medical Medical Records Mental Depression Outcome Outpatients Palliative Care Patients Philosophy Pilot Projects Play Problem Solving Psychosocial Assessment and Care Publishing Quality of life Randomized Randomized Controlled Trials Recommendation Reporting Resources Role Self Care Self Determination Self Efficacy Services Social support Spouses Supportive care Surveys Symptoms Telephone Testing Training Training Support United States Volition Work active method base caregiver interventions caregiving coping efficacy testing emotional distress empowered experience family support follow-up hospice environment improved medical specialties mortality multidisciplinary outreach palliative physical symptom point of care programs psychosocial public health relevance respite care satisfaction skills skills training stress management symptom management theories

项目摘要

DESCRIPTION (provided by applicant): The profound symptom burden associated with advanced lung cancer (LC) makes caregiving a complex and burdensome task. Despite the input of outpatient palliative care services, LC families are often unprepared for caregiving, have low self-efficacy for managing symptoms at home, report high rates of physical and emotional distress, and receive very little skills training or psychosocial care. To date, the few psychosocil intervention trials targeting the caregivers of advanced cancer patients that have been conducted have mostly targeted the families of hospice patients, have not been well-integrated into routine palliative care, and have not addressed the specific needs of LC caregivers. Based on our published and recently completed pilot work in LC, we have developed a psychosocial intervention called CareSTEPS (self-Care, Stress management, sympTom management, Effective communication, Problem-solving, and Social support). CareSTEPS is grounded by Self Determination Theory (SDT) which focuses on individuals' needs for developing autonomy (a sense of choice and volition), competence (self-efficacy), and relatedness (a sense of belonging and connection). It: 1) teaches skills to enhance caregiver competence for managing symptoms, practicing self-care, and coping with cancer~ 2) supports caregiver autonomy by providing a clear rationale for recommendations and a variety of options to encourage choice and elaboration~ and, 3) seeks to improve caregivers' sense of relatedness by teaching strategies for effective communication and soliciting/accepting social support. We will enroll 200 LC patients within one month of treatment initiation (baseline) and their caregivers and randomize them to either a usual medical care (UMC) condition or the CareSTEPS intervention (caregivers receive a manual and six 45-minute weekly counseling sessions by telephone). Follow-up surveys are completed at 8 weeks and 6 months post-baseline. The primary aim is to determine the impact of the CareSTEPS intervention on caregiver self-care behaviors, physical and emotional QOL, and satisfaction with care. Secondary aims are to: 1a) examine the effects of CareSTEPS on the SDT constructs of competence, autonomy, and relatedness~ 1b) test whether caregiver competence, autonomy and relatedness mediate the effects of CareSTEPS on caregiver outcomes as hypothesized~ 2) explore whether sociodemographic, medical, and relationship factors moderate the effects of the CareSTEPS intervention on SDT constructs~ and, 3) explore the effects of CareSTEPS on patient QOL, palliative care utilization, nd satisfaction with care. CareSTEPS fills an important service gap by providing education, skills training, and support to the caregivers of advanced LC patients who are on active treatment. The home-based delivery format will facilitate future dissemination and outreach. By empowering families with the skills they need to provide care and meet the challenges of LC, CareSTEPS holds great promise for improving caregiver QOL, patient QOL, and the quality of palliative/supportive care services for advanced cancer patients and their families.

描述（由申请人提供）：与晚期肺癌（LC）相关的深刻症状负担使护理使护理成为一项复杂而繁重的任务。尽管有门诊姑息治疗服务的投入，但LC家庭经常没有准备好照顾，在家中管理症状的自我效能低下，报告高度的身体和情绪困扰率，并获得很少的技能培训或社会心理护理。迄今为止，针对已进行的晚期癌症患者护理人员的少数精神病干预试验主要针对临终关怀患者家属，尚未完全融入常规姑息治疗，并且没有满足LC护理人员的特定需求。根据我们在LC中发表的并完成的试点工作，我们开发了一种名为Caresteps的社会心理干预措施（自我护理，压力管理，症状管理，有效的沟通，解决问题和社会支持）。 Caresteps以自我确定理论（SDT）为基础，该理论的重点是个人的需求发展自主权（一种选择和意志感），能力（自我效能）和相关性（归属感和联系感）。 IT：1）教授技能以增强护理人员的能力来管理症状，练习自我护理和应对癌症〜2）通过为建议和各种选择提供明确的理由，以鼓励选择和精心设计和阐述，从而支持护理人员的自主权，以提高护理人员通过有效的沟通和良好的社交服务来提高护理人员的相关性。我们将在治疗启动（基线）及其护理人员的一个月内注册200名LC患者，并将其随机纳入通常的医疗护理（UMC）状况或Caresteps干预措施（护理人员通过电话收到手动和六次45分钟的每周辅导时间）。后续调查在基线后8周零6个月完成。主要目的是确定Caresteps干预对护理人员自我保健行为，身体和情感质量的影响以及对护理的满意度。次要目的是：1A）检查CARESTEPS对能力，自主权和相关性的SDT结构的影响。 Caresteps对患者QOL的影响，姑息治疗利用率，对护理的满意度。 Caresteps通过为正在进行积极治疗的高级LC患者的护理人员提供教育，技能培训和支持来填补重要的服务差距。基于家庭的交付格式将促进未来的传播和外展。通过使家庭能够提供护理和应对LC的挑战所需的技能，Caresteps对改善护理人员QOL，患者QOL以及为高级癌症患者及其家人提供了姑息/支持服务的质量。