Patient and family participation in hospice team meeting

描述（由申请人提供）：与NCI的挑战目标一致，即消除癌症带来的痛苦，以及与患者护理相关的公共卫生使命，本提案旨在测试一种新的干预措施，该干预措施将改善生命末期的护理质量，并改善垂死的癌症患者和家属的生活质量。本计划建议透过使用市售的可视电话，让病人/家属参与安宁疗护跨学科团队，以加强对癌症病人的安宁疗护。本探索性专案的总体目的，是透过让癌症病患与家属照护者参与安宁疗护IDT会议，来测试一种改善临终照护的干预措施。假设癌症患者及其主要家庭照护者积极参与安宁疗护IDT会议，将改善沟通、疼痛管理和生活品质。探索性研究将允许测试干预后勤，确定抽样和招募问题，评估定性方法，以及测试特定工具。本研究的目的是：1)使用观察和访谈来探讨团队与患者/家属之间的沟通；2)测试方法来评估疼痛和症状管理的变化；3)测试方法来评估生活质量的变化。Saltz和Schaefer提出的理论模型主张对IDT的背景、过程、结构和结果进行评估，作为让患者和家庭参与IDT的基础。这种探索性干预采用准实验设计，采用顺序两阶段混合方法，包括定性和定量方法并行和平等地位。定性设计包括对团队会议的观察和对家庭成员的访谈。定量部分使用以前使用的工具来衡量参加IDT会议的结果。第一阶段包括观察和测量未参加IDT会议的安宁疗护癌症患者，以作为对照组。第二阶段引入可视电话作为一种工具，以支持患者和家属参与IDT会议。这项研究的结果将为一个更大的多阶段、多地点的后续项目提供初步数据。

DESCRIPTION (provided by applicant): In congruence with the NCI challenge goal to eliminate suffering due to cancer, and its public health mission related to patient care, this proposal seeks to test a new intervention which will improve the quality of care at the end of life and quality of life for dying cancer patients and family. This project proposes to strengthen hospice care for cancer patients by enabling patient/family participation in hospice interdisciplinary teams (IDTs) through use of a commercially available videophone. The overall purpose of this exploratory project is to test an intervention to improve end of life care by involving cancer patients and family caregivers in hospice IDT meetings. The hypothesis is that the active participation of cancer patients and their primary family caregiver in the hospice IDT meeting will improve communication, pain management and quality of life. The exploratory study will allow for testing of the intervention logistics, identifying sampling and recruitment issues, assessing the qualitative methodology, and testing of specific instruments. The study aims to:1) use observation and interviews to explore communication between the team and patient/family, 2) test measures to assess changes in pain and symptom management, and 3) test measures to assess changes in quality of life. The theoretical model developed by Saltz and Schaefer advocate the assessment of the IDT context, process, structure, and outcomes as a foundation for involving patients and families in the IDT. This exploratory intervention uses a quasi-experimental design in a sequential two-phase mixed methods approach involving qualitative and quantitative methods in parallel and equal status. The qualitative design includes observations of team meetings and interviews with family members. The quantitative component uses previously used instruments to measure the outcomes of participation in IDT meetings. Phase I involves the observation and measurement of hospice cancer patients who are not involved in the IDT meeting to serve as a comparison group. Phase II introduces the videophone as a tool to support patient and family involvement in the IDT meeting. The results of this study will provide preliminary data for a larger multi-phase, multi-site follow-up project.