A CAREGIVER INTERVENTION TO IMPROVE HOSPICE OUTCOMES

尽管临终关怀家庭照顾者得到了临终关怀团队的支持，但研究表明，需要更多的支持和教育，以帮助他们承担起身体和情感护理的巨大责任。如果护理者没有做好充分的准备来评估患者并提供所需的护理，患者的生活质量可能会受到影响，护理者可能会体验到不足、焦虑和抑郁的感觉，从而导致护理者的生活质量下降。这项基于压力过程模型的实验研究的主要目的是通过帮助临终关怀人员掌握更好地评估和管理癌症患者经历的特定问题(疼痛、呼吸困难、便秘)所需的技能，从而提高护理人员对患者症状压力的应对和自我评估，以及患者和护理人员的生活质量，从而提高临终关怀人员的生活质量。480名患者/护理者的样本将从当地的一家大型临终关怀机构中提取，并使用功能状态和精神状态的测量进行筛选。同意后，受试者将被随机分为三组，一组接受标准护理(I组)，一组接受标准护理加友好探访(II组)，一组接受标准护理加干预组(III组)。干预将基于COPE方法(创造力、乐观主义、计划、专家信息)。第二组和第三组将按相同的时间表接受访问，以控制研究人员时间和注意力的影响。在第一次访问中，第三组的照顾者将被教导使用COPE方法来处理患者的问题。第一次访问将持续大约90分钟；第二次访问和第三次访问将加强和延长学习，每次大约30分钟。第三组照顾者将收到一份晚期癌症家庭护理指南，并收到RA干预护士打来的两个支持性电话，一个是在第一次访问之后，另一个是在第二次访问之后。第三组护理者将学习如何评估患者的症状强度，并给出一份预先格式化的日记，每天两次记录症状强度分数。将从患者那里收集有关症状强度、症状苦恼和生活质量的数据。照顾者的数据将包括应对、自我评估和包括掌握情况在内的生活质量。数据将从所有三组在入院时、干预后立即(第16天)和入院后4周(第30天)收集。在入住临终关怀中心一年后，将再次联系所有照顾者收集数据(预计患者将死亡)。定量数据将使用重复测量、多变量方差分析和结构方程建模进行分析。

Although hospice family caregivers receive support from the hospice team, research indicates that a greater level of support and education are needed to assist them with the enormous responsibility they bear for physical and emotional care. If the caregiver is not adequately prepared to assess patients and provide needed care, the patient's quality of life may suffer, and the caregiver may experience feelings of inadequacy, anxiety, and depression leading to decreased caregiver quality of life. The primary aim of this experimental study, based on the stress-process model, is to improve the quality of life of hospice caregivers by helping them to master the skills needed to better assess and manage specific problems experienced by cancer patients (pain, dyspnea, constipation), thus enhancing caregiver coping and self-appraisal of stressfulness of patient symptoms and quality of life for both patients and caregivers. The sample of 480 patient/caregiver dyads will be drawn from a large hospice in the local area and screened using measures of functional status and mental status. After consenting, subjects will be randomly divided into three groups, a control group receiving standard care (Group I), a group receiving standard care plus friendly visits (Group II), and a group receiving standard care plus the intervention (Group III). The intervention will be based on the COPE method (Creativity, Optimism, Planning, Expert Information). Groups II and III will receive visits on the same schedule to control for the effects of researcher time and attention. On visit one, caregivers in Group III will be taught to use the COPE method of managing patient problems. Visit one will last approximately 90 minutes; visits two and three will reinforce and extend learning and last approximately 30 minutes each. Group III caregivers will receive a copy of the Home Care Guide for Advanced Cancer and receive two supportive telephone calls from the RA-intervention nurse, one after visit one and one after visit two. Group III caregivers will be taught how to assess patient symptom intensity and given a preformatted diary in which to record symptom intensity scores twice daily. Data will be collected from patients about symptom intensity, symptom distress, and quality of life. Caregiver data will include coping, self-appraisal, and quality of life including mastery. Data will be collected from all three groups on admission to the study, immediately post intervention (day 16), and four weeks after admission to the study (day 30). One year after admission to hospice, all caregivers again will be contacted for data collection (patients are expected to be deceased). Quantitative data will be analyzed using repeated measures multivariate analysis of variance and structural equation modeling.