Caregiver Support in the Context of Multiple Chronic Conditions (Caregiver-Support)

多种慢性病背景下的护理人员支持（护理人员支持）

• 批准号: 9768556
• 负责人: Martha Allison Abshire
• 金额: --
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9768556
• 关键词: Address; Adult; Affect; Affective; Area; Cardiology; Caregiver Burden; Caregiver support; Caregivers; Caring; Cells; Chronic; Chronic Disease; Clinic; Clinical Trials; Cognitive; Communities; Complex; Cost Savings; Development; Economics; Elderly; Evaluation; Family; Family Caregiver; Family Relationship; Family health status; Family member; Fatigue; Financial Hardship; Future; Gender; Goals; Health; Health Personnel; Health Status; Healthcare; Healthcare Systems; Heart failure; Home environment; Hormones; Impairment; Individual; Inflammatory; Interleukin-10; Interleukin-6; Intervention; Left; Life; Low income; Masks; Measures; Mediator of activation protein; Methodology; Methods; Mission; Modality; Nurses; Outpatients; Patient Self-Report; Patients; Personal Satisfaction; Persons; Physiological; Pilot Projects; Problem Solving; Process; Quality of life; Research; Research Personnel; Resources; Rewards; Risk; Role; Scientist; Social isolation; Social support; Societies; Stigmatization; Stress; Sweat; Syndrome; Testing; United States; Vulnerable Populations; base; burden of illness; career; caregiver interventions; caregiving; checkup examination; contextual factors; coping; cytokine; design; effective intervention; experience; family caregiving; family support; follow-up; health care service utilization; high risk; improved; improved outcome; innovation; loved ones; medical specialties; mortality; multidisciplinary; multiple chronic conditions; person centered; personalized intervention; physical conditioning; primary outcome; racial diversity; randomized trial; resilience; secondary outcome; stressor; successful intervention; theories

Abstract Supporting caregivers of adults with multiple chronic conditions to reduce burden, increase resilience and improve quality of life (QOL) is a national healthcare priority. Yet tailoring this support to the priorities of the caregiver is challenging due to limited number of tested interventions as well as the stigmatizing and gender- bound considerations in caregiving, underscoring the need for future research. Dr. Abshire will test the feasibility of a tailored intervention with family caregivers of people with advanced heart failure and at least one other chronic condition. Often HF patients with complex health needs due to multiple chronic conditions have functional limitations requiring a family caregiver (family and unpaid caregivers) and as the difficulty of caregiving tasks and amount of care increases there is an increased risk for worsening caregiver role strain, burden, and impairment of QOL. This study will be based on principles from the Society to Cells Framework, which posits that physiological, individual, family and societal level factors influence resilience, the process of positive adaptation when facing stressors. We will use co-design, which incorporates end users as key stakeholders, including patients and caregivers, in the design, development, execution and evaluation of a project to develop and pilot test a theoretically-derived, person- and family-centered intervention. Using co- design methodology, Dr. Abshire and co-investigators will engage persons experiencing multiple chronic conditions including heart failure, caregivers, healthcare providers and expert interventionists in the development of a caregiver-specific intervention focusing on resilience-building. Partnered with a specialty outpatient cardiology clinic, the Johns Hopkins Heart Failure Bridge Clinic, we will develop a home-based intervention to help caregivers articulate statements of purpose in life, set goals to address fatigue and caregiver burden, provide instrumental support (e.g. benefits check up) and social support to improve self- reported QOL (affective well-being and physical health) from baseline to 16 week follow-up. The pilot study will be a single-masked, two-group, randomized trial (N=45) and will test the feasibility and gauge an initial effect size of the intervention in a racially diverse, low-income urban community. She will also test whether self- reported fatigue and caregiver burden are associated with higher inflammatory cytokines (Il-6 and IL-10) as detected in sweat patches, controlling for covariates. Dr. Abshire uses the period of caregiving as a period in which to leverage resilience. The proposed study is innovative in several critical ways: Supporting caregivers of patients with MCC and HF to discuss their purpose in life, set their own individualized goals, while providing instrumental and social support is both a person- and family-centered approach to improve QOL. Finally, we are using an innovative co-design method which will address a gap in effective interventions to meet the needs of caregivers of a multimorbid, vulnerable population through theory-driven research. This is directly aligned with the NINR mission to develop interventions that reduce illness burden by providing caregiver support.

抽象的 支持患有多种慢性病的成年人的护理人员，以减轻负担，增加韧性和 改善生活质量（QOL）是国家医疗保健的优先事项。然而，根据 由于经过测试的干预措施数量有限以及污名化和性别，护理人员的挑战 护理中的有限考虑，强调了对未来研究的需求。 Abshire博士将测试 与患有晚期心力衰竭的人的家庭护理人员量身定制干预的可行性 另一种慢性病。由于多种慢性病，通常患有复杂健康需求的HF患者 有需要家庭护理人员（家庭和无薪照顾者）的功能限制，并且很难 护理任务和护理数量增加，护理人员角色压力的风险增加， 负担和质量障碍。这项研究将基于从社会到细胞框架的原理， 这认为生理，个人，家庭和社会层面因素会影响韧性 面对压力源时的阳性适应性。我们将使用共同设计，该设计将最终用户作为关键 利益相关者，包括患者和照料者，在设计，开发，执行和评估中 开发和试点的项目测试理论上以人为中心和家庭为中心的干预措施。使用共同 设计方法论，Abshire博士和共同投资者将与经历多个慢性的人互动 包括心力衰竭，护理人员，医疗保健提供者和专家干预者在内的条件 开发针对弹性建设的特定于护理人员的干预措施。与专业合作 约翰·霍普金斯心力衰竭桥诊所门诊心脏病学诊所，我们将开发一个基于家庭的家庭 干预以帮助看护人阐明人生目的的陈述，设定目标以解决疲劳和 护理人员负担，提供工具支持（例如，福利检查）和社会支持以改善自我 据报道，从基线到16周的随访QOL（情感福祉和身体健康）。试点研究将 成为一个掩盖的两组，随机试验（n = 45），将测试可行性并衡量初始效果 在种族多样化的低收入城市社区中干预的规模。她还将测试自我 报道的疲劳和护理人员负担与较高的炎症细胞因子（IL-6和IL-10）有关 在汗水斑块中检测到，控制协变量。 Abshire博士将护理时期作为一段时间 要利用弹性。拟议的研究以几种关键方式具有创新性：支持 MCC和HF患者讨论他们在生活中的目的，设定自己的个性化目标，同时提供 乐器和社会支持既是以人为和家庭为中心的方法来改善QoL。最后，我们 正在使用创新的共同设计方法，该方法将解决有效干预措施的差距以满足需求 通过理论驱动的研究，多种危险，脆弱人群的护理人员的照顾者。这是直接对齐的 尼尔的使命是制定干预措施，通过提供护理人员的支持来减轻疾病负担。