A Multimedia Self-Management Intervention to Prepare Family Caregivers and Patients for Lung Cancer Surgery

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Project Summary - The overall purpose of this proposal is to test the efficacy of a Multimedia Self- Management (MSM) Intervention to prepare 160 caregiver-patient dyads for lung cancer surgery. This research is critical because lung cancer patients are discharged from the hospital earlier after surgery despite an aging population (age 65 and older) that suffers from greater co-morbidities and decreased quality of life (QOL). As a result, the bulk of the caregiving burden after surgery has fallen on family caregivers (FCGs). This randomized trial is designed to integrate the fields of nursing, FCG research and thoracic surgery in order to develop a dyadic model of care that can become a standard of care in cancer surgery. This multiple PD/PI proposal leverages the clinical and research expertise of the two PIs (Sun: nursing, FCG research; Kim: surgery) by testing the MSM Intervention to impact key FCG and patient variables that influence their quality of life and the quality of care after lung cancer surgery. Based on the Chronic Care Self-Management Model (CCM), the MSM Intervention is a nurse-led, caregiver-based, multimedia care model for lung cancer surgery. Its primary focus is 1) to provide one-on-one coaching with lung cancer FCGs on post-operative caregiving and managing their QOL needs; and 2) to target FCG-patient dyadic knowledge and skills in preparing for surgery and post-operative recovery activities. The intervention includes video, handbook, and nurse phone calls after hospital discharge. It is administered at five time points: before surgery, during hospitalization, and at 3 time points (day 2, day 7, and 2 months) after discharge. We will test the efficacy of the MSM Intervention using a randomized trial of attention control group versus an intervention group to pursue the following specific aims: Specific Aim 1: Test the effects of the MSM Intervention on FCG outcomes and cancer support services use; Specific Aim 2: Test the effects of the MSM Intervention on patient outcomes and healthcare resource use; Specific Aim 3: Test the effects of the MSM Intervention on outcome mediators (activation, self-efficacy, knowledge); Exploratory Aim 1: Explore moderators (age, sex, marital status, caregiver relationship to patient, caregiver employment status, co-morbidities) of FCG and patient outcomes and reciprocal relationships; Exploratory Aim 2: Determine, through exit interviews, participant's experience with the MSM intervention. This proposal is innovative because it merges the science of cancer caregiving, self- management, and thoracic surgery in order to improve the care of cancer surgery patients. This proposal is significant because the outcomes which are being studied have been cited to be of critical importance to FCGs, patients, surgeons, the National Cancer Institute, and the Institute of Medicine; these outcomes include psychological distress, caregiver burden, quality of life, and healthcare resource use. The long-term goal is to prove that the CCM can be applied to patients with lung cancer and their FCGs to better prepare them for surgery, improve postoperative outcomes, and optimize healthcare resource/cancer support services use.