A communication-based intervention for advanced cancer patient-caregiver dyads to increase engagement in advance care planning and reduce caregiver burden

针对晚期癌症患者-护理人员二人组的基于沟通的干预措施，以增加对预先护理计划的参与并减轻护理人员的负担

• 批准号: 9789230
• 负责人: Kelly McConnell
• 金额: $ 22.18万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789230
• 关键词: Address; Adherence; Advance Care Planning; Advanced Malignant Neoplasm; Benchmarking; Breathing; Cancer Center; Cancer Patient; Caregiver Burden; Caregivers; Caring; Cessation of life; Cognitive; Collaborations; Communication; Decision Making; Distress; Do Not Resuscitate Order; Family; Feedback; Foundations; Friends; Fright; Future; Goals; Health Care Costs; Healthcare; Home environment; Intervention; Learning; Life; Life Expectancy; Living Wills; Measures; Methods; Muscle relaxation phase; Nature; Outcome; Palliative Care; Participant; Patient Care; Patient Self-Report; Patients; Play; Proxy; Public Health; Quality of Care; Randomized Clinical Trials; Relaxation Techniques; Reporting; Research; Research Personnel; Role; Surgeon; Techniques; Telephone; Terminally Ill; Testing; Treatment Efficacy; Treatment Futility; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Validation; Work; base; cancer care; caregiver bereavement; college; distress tolerance; emotional distress; end of life; end of life care; experience; health care service utilization; health goals; improved; innovation; member; novel; novel strategies; outcome forecast; participant retention; patient engagement; post intervention; preference; primary outcome; prognostic; programs; psychological distress; psychosocial; response; satisfaction; secondary outcome; skills; social; standard care; theories; therapy design

PROJECT SUMMARY Accurate prognostic understanding is a critical predictor of patients' engagement in advance care planning (ACP) and receipt of less futile, aggressive care at the end of life. However, approximately half of advanced cancer patients do not understand the terminal nature of their illness. Caregivers play an integral role in patients' care and decision-making at the end of life, yet few interventions include them. Drs. Shen and Trevino's pilot work, in collaboration with their Co-Investigators Drs. Prigerson and Maciejewski, suggests that improving both patient and caregiver prognostic understanding surrounding the patient's terminal status and estimated life expectancy is associated with higher rates of engagement in ACP. Based on this pilot work and the important role of caregivers in end-of life (EOL) cancer care, this study aims to develop a communication- based intervention to improve advanced cancer patients' and caregivers' prognostic understanding. The goals of this study are to: (1) develop a communication-based intervention to improve advanced cancer patients' and caregivers' prognostic understanding using communication strategies (e.g., acknowledgment, validation of fears) and distress management techniques (e.g., deep breathing, muscle relaxation); (2) evaluate the feasibility and acceptability of the intervention among advanced cancer patients and their caregivers; and (3) test the preliminary efficacy of the intervention on patients' and caregivers' prognostic understanding (primary outcome); completion of DNR order, living will, and health care proxy; psychological distress; communication quality; caregiver burden; and healthcare utilization (secondary outcomes). To meet these goals, we will collect feedback from advanced cancer patients and their caregivers (n=10 dyads) and psychosocial experts (n=10) to improve and refine the intervention. Next, we will pilot test the intervention with n=30 patient-caregiver dyads and assess outcomes at baseline, post-intervention, and three months later to determine the feasibility, acceptability, and preliminary efficacy of the intervention on improving engagement in ACP and communication, reducing distress and caregiver burden, improving rates of goal-concordant care, and reducing rates of futile aggressive care. These results will inform a future NIH R01 application to conduct a large-scale randomized clinical trial (RCT) of intervention efficacy. Grounded in established theories of inhibitory learning and social-cognitive processing, the present study takes the novel approach of integrating communication and distress management techniques to improve patients' and caregivers' ability to discuss difficult EOL topics while managing the distress associated with these topics. It is expected that these results will form a strong foundation for a program of research focused on integrating caregivers into interventions targeting advanced cancer patients as a novel and innovative way to improve engagement in ACP, increase rates of goal- concordant care, and reduce receipt of futile, aggressive EOL care.

项目概要 准确的预后理解是患者参与预先护理计划的关键预测因素 (ACP) 并在生命临终时得到较少徒劳的、积极的护理。然而，大约一半的高级 癌症患者不了解其疾病的晚期性质。照顾者在其中发挥着不可或缺的作用 患者临终时的护理和决策，但很少有干预措施将其纳入其中。博士。沉和 特雷维诺的试点工作，与他们的共同研究人员合作。 Prigerson 和 Maciejewski 认为 提高患者和护理人员对患者临终状态的预后了解， 预计预期寿命与较高的 ACP 参与率相关。基于本次试点工作和 鉴于护理人员在临终 (EOL) 癌症护理中的重要作用，本研究旨在建立一种沟通- 基于干预措施，以提高晚期癌症患者和护理人员对预后的了解。目标 本研究的目的是：（1）开发一种基于沟通的干预措施，以改善晚期癌症患者的 护理人员使用沟通策略（例如，确认、验证 恐惧）和压力管理技巧（例如深呼吸、肌肉放松）； (2) 评估 晚期癌症患者及其护理人员干预的可行性和可接受性；和（3） 测试干预措施对患者和护理人员预后理解的初步效果（主要 结果）;完成 DNR 命令、生前遗嘱和医疗保健委托书；心理困扰；沟通 质量;照顾者的负担；和医疗保健利用（次要结果）。为了实现这些目标，我们将收集 晚期癌症患者及其护理人员（n=10 组）和社会心理专家（n=10）的反馈 改进和完善干预措施。接下来，我们将用 n=30 名患者-护理人员二人组来试点测试干预措施 并评估基线、干预后和三个月后的结果以确定可行性， 干预措施在提高 ACP 参与度方面的可接受性和初步效果 沟通，减少痛苦和护理人员负担，提高目标一致护理的比率，并减少 积极治疗无效的比率。这些结果将为未来的 NIH R01 应用提供信息，以进行大规模的 干预效果的随机临床试验（RCT）。以既定的抑制学习理论为基础 和社会认知处理，本研究采用了整合沟通和认知处理的新颖方法 苦恼管理技术可提高患者和护理人员讨论困难的 EOL 话题的能力 同时管理与这些主题相关的痛苦。预计这些结果将形成强有力的 一个研究计划的基础，重点是将护理人员纳入针对先进的干预措施 癌症患者作为一种新颖和创新的方法来提高 ACP 的参与度，提高目标率 一致的护理，并减少接受无效的、积极的 EOL 护理。