Patient and family participation in hospice team meeting

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DESCRIPTION (provided by applicant): In congruence with the NCI challenge goal to eliminate suffering due to cancer, and its public health mission related to patient care, this proposal seeks to test a new intervention which will improve the quality of care at the end of life and quality of life for dying cancer patients and family. This project proposes to strengthen hospice care for cancer patients by enabling patient/family participation in hospice interdisciplinary teams (IDTs) through use of a commercially available videophone. The overall purpose of this exploratory project is to test an intervention to improve end of life care by involving cancer patients and family caregivers in hospice IDT meetings. The hypothesis is that the active participation of cancer patients and their primary family caregiver in the hospice IDT meeting will improve communication, pain management and quality of life. The exploratory study will allow for testing of the intervention logistics, identifying sampling and recruitment issues, assessing the qualitative methodology, and testing of specific instruments. The study aims to:1) use observation and interviews to explore communication between the team and patient/family, 2) test measures to assess changes in pain and symptom management, and 3) test measures to assess changes in quality of life. The theoretical model developed by Saltz and Schaefer advocate the assessment of the IDT context, process, structure, and outcomes as a foundation for involving patients and families in the IDT. This exploratory intervention uses a quasi-experimental design in a sequential two-phase mixed methods approach involving qualitative and quantitative methods in parallel and equal status. The qualitative design includes observations of team meetings and interviews with family members. The quantitative component uses previously used instruments to measure the outcomes of participation in IDT meetings. Phase I involves the observation and measurement of hospice cancer patients who are not involved in the IDT meeting to serve as a comparison group. Phase II introduces the videophone as a tool to support patient and family involvement in the IDT meeting. The results of this study will provide preliminary data for a larger multi-phase, multi-site follow-up project.