Symptom Care by Phone for Hospice Caregiver Support and Cancer Symptom Relief

死于癌症的人通常在家里度过他们的一生，伴随着一系列控制不良的症状。 无效的症状管理部分是由于患者离开医院后监测不足造成的。 治疗为重点的竞技场的临床设置。症状的变化模式是具有挑战性的护理 战略和建议，从以前遇到的医疗保健提供者成为迅速 过时了临终关怀的负担主要福尔斯落在家庭照顾者身上，通常是配偶或伴侣， 在提供身体和支持性护理方面感到巨大的压力，但往往缺乏知识和技能 从而导致可能延伸到丧亲之痛的显著的照顾者负担和痛苦。 这项前瞻性临床试验旨在测试电信系统。通过电话进行症状护理- 临终关怀旨在弥合家庭和姑息治疗支持之间的鸿沟， 生命的终结和他们的家庭照顾者。SCP-临终关怀有三个要素：1）每天监测12 生命初期常见的症状，2）自动提醒临终关怀RN病例管理器有关症状 已经超过症状严重性或痛苦的预设阈值，以及3）自动化，及时， 定制护理管理策略，供护理人员实施，以解决患者的症状。 护理人员每天致电SCP临终关怀系统报告患者症状，然后立即提供 自动化的、定制的护理建议与特定的症状特征配对。 样本将包括300名癌症患者的配偶/伴侣照顾者，年龄在50岁以上， 接受了家庭临终关怀计划和他们的临终关怀RN个案经理。护理参与者将 随机分配至SCP-临终关怀干预组或常规临终关怀组。 该研究的具体目的是测试SCP-临终关怀干预是否降低了严重程度， 12种不同症状的痛苦以及它是否减少了照顾者的负担，焦虑，抑郁情绪 与常规护理相比，可减轻患者的症状和痛苦，并改善护理人员的睡眠。 解释SCP临终关怀如何影响这些结果的机制也将被探讨。其他目标将 比较护理人员使用的患者护理策略，并评估护理人员和临终关怀RN的满意度 SCP系统。此外，利用本项目其他两个研究项目的数据， 两个协同目标将检查SCP干预对临终关怀RN照顾者质量的影响 关于未缓解症状的沟通，并确定护理人员是否使用SCP-临终关怀 与常规护理相比，在丧亲期间经历较少的抑郁和改善的调整。

Individuals dying from cancer often live out their lives at home with a host of poorly controlletd symptoms. Ineffective symptom management results, in part, from inadequate monitoring of patients once they leave the treatment-focused arena of the clinical setting. The changing pattern of symptoms is challenging as care strategies and recommendations from previous encounters with healthcare providers become quickly outdated. The burden of end-of-life care largely falls to family caregivers, usually a spouse or partner, who feel enormous pressure to provide physical and supportive care but often lacks the knowledge and skill resulting in significant caregiver burden and distress that may extend into bereavement. This prospective, clinical trial proposes to test a telecommunication system. Symptom Care by Phone- Hospice that has been designed to bridge the divide between home and palliative care support for patients at the end of life and their family caregiver. SCP-Hospice has three elements: 1) daily monitoring of 12 symptoms common at entj of life, 2) automated alerting of the hospice RN case manager about symptoms that have exceeded a pre-set threshold for symptom severity or distress, and 3) automated, just in time, tailored care management strategies for the caregiver to implement to address the patient's symptoms. Caregivers call the SCP-Hospice system daily to report patient symptoms and then are immediately provided automated, tailored care suggestions paired to the specific symptom profile. The sample will consist of 300 spouse/partner caregivers of cancer patients, 50+ years of age newly admitted to a home hospice program and their hospice RN case manager. Caregiver participants will be randomized to the SCP-Hospice intervention or to usual hospice care. The specific aims of the study are to test whether the SCP-Hospice intervention reduces severity and distress from 12 different symptoms and whether it decreases caregiver burden, anxiety, depressed mood and distress about the patient's symptoms and improves caregiver sleep when compared with usual care. The mechanisms that explain how SCP-Hospice affect these outcomes also will be explored. Other aims will compare patient care strategies utilized by caregivers and evaluate caregiver and Hospice RN satisfaction with the SCP system. In addition, utilizing data from the other two research projects in this program project, two synergistic aims will examine the impact of the SCP intervention on the quality of hospice RN-caregiver communication about unrelieved symptoms and determine whether caregivers utilizing SCP-Hospice experience less depression and improved adjustment during bereavement in comparison to usual care.