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.

项目总结