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

死于癌症的人通常在家中度过他们的一生，伴随着一系列控制不好的症状。 症状管理不力的部分原因是，一旦患者离开医院，对他们的监控不足。 临床环境中以治疗为重点的领域。不断变化的症状模式是具有挑战性的护理 从之前与医疗保健提供者的接触中得出的战略和建议很快就变得 已经过时了。临终关怀的负担主要落在家庭照顾者身上，通常是配偶或伴侣，他们 感到提供身体和支持性护理的巨大压力，但往往缺乏知识和技能 导致照顾者的巨大负担和痛苦，可能会延伸到丧失亲人。 这项前瞻性的临床试验计划测试一种电信系统。通过电话提供症状护理- 临终关怀，旨在弥合家庭和临终关怀之间的鸿沟，为患者提供 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 生命中常见的ENTJ症状，2)临终关怀RN病例经理关于症状的自动警报 已经超过症状严重程度或痛苦的预设阈值，以及3)及时、自动地， 为照顾者实施量身定做的护理管理策略，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、量身定做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，新年龄在50岁以上 获准参加家庭临终关怀计划和他们的临终关怀RN病例经理。护理者参与者将是 随机分为SCP-临终关怀干预组或常规临终关怀组。 这项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和 来自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 与通常的护理相比，它可以减少患者症状的痛苦，并改善护理者的睡眠。 解释SCP-临终关怀如何影响这些结果的机制也将被探索。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中心的满意度 使用SCP系统。此外，利用本计划项目中另外两个研究项目的数据， 两个协同目标将检验SCP干预对临终关怀RN-照顾者质量的影响 沟通未缓解的症状，并确定照顾者是否使用SCP-临终关怀 与通常的护理相比，在丧亲期间经历更少的抑郁和更好的调整。

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is challenging as care strategies and recommendations from previous encounters with healthcare providers become quickly outdated.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.