A CAREGIVER INTERVENTION TO IMPROVE HOSPICE OUTCOMES

虽然临终关怀家庭照顾者得到临终关怀团队的支持，但研究表明，需要更高水平的支持和教育，以帮助他们承担身体和情感护理的巨大责任。 如果护理者没有充分准备好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，并且护理者可能会经历不充分、焦虑和抑郁的感觉，导致护理者生活质量下降。本实验研究的主要目的，压力过程模型的基础上，是提高临终关怀照顾者的生活质量，帮助他们掌握所需的技能，以更好地评估和管理癌症患者所经历的具体问题（疼痛，呼吸困难，便秘），从而提高照顾者应对和自我评价的患者症状和患者和照顾者的生活质量的压力。 480名患者/护理人员的样本将从当地一家大型临终关怀医院抽取，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，接受标准治疗的对照组（I组）、接受标准治疗加友好访视的组（II组）和接受标准治疗加干预的组（III组）。 干预将基于科普方法（创造力，乐观，规划，专家信息）。 第二组和第三组将按照相同的时间表接受访视，以控制研究人员时间和注意力的影响。 在第一次访视时，第三组的护理人员将被教导使用科普方法管理患者问题。 第一次访问将持续约90分钟;第二次和第三次访问将加强和扩展学习，每次持续约30分钟。 第III组护理人员将收到一份晚期癌症家庭护理指南，并收到RA干预护士的两个支持性电话，一个在访视1后，一个在访视2后。 第III组护理人员将被教导如何评估患者症状强度，并提供一份预先格式化的日记，每天两次记录症状强度评分。 将从患者中收集有关症状强度、症状困扰和生活质量的数据。 照顾者的数据将包括应对，自我评价和生活质量，包括掌握。将在进入研究时、干预后立即（第16天）和进入研究后四周（第30天）从所有三组中收集数据。 入院一年后，将再次联系所有护理人员收集数据（预计患者已死亡）。 将使用重复测量多变量方差分析和结构方程模型分析定量数据。

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.