Hospice Nurse-Caregiver Communication: Implications for Caregiving & Bereavement

随着医疗保健越来越多地进入家庭，越来越多的非正式护理人员正在寻求家庭临终关怀服务的帮助，以获得临终癌症护理。照顾者的信息，身体和情感问题可能会在患者癌症的最后阶段以及照顾者进入丧亲之痛的过程中发生变化。临终关怀RN个案经理的一个关键任务是通过引起照顾者的关注来促进照顾者需求的管理。护士和照顾者之间的有效沟通有可能加强对病人的症状管理，减轻照顾者的负担，并改善丧亲之痛的调整。虽然有效的沟通，在生命的尽头已被认为是至关重要的，是必不可少的最佳临终病人护理，很少有系统的研究已经进行了关于这个问题。一个重要的差距仍然是在我们的理解护士照顾者的沟通过程中结束的生命护理。在癌症病人的临终关怀，护士和照顾者发展的工作/照顾关系，他们的沟通的性质可能会有所不同，根据死亡过程的动态性质。在这项观察性研究中，我们将研究护士和照顾者之间的沟通过程中的多个家庭为基础的遭遇。该项目以病人为中心的沟通框架为指导，重点是由全国优质姑息治疗共识项目建立的关键护理领域（身体，心理和精神）。我们计划为300名家庭临终关怀肿瘤患者的护士和配偶/伴侣照顾者之间的所有面对面接触进行录音。所有的遭遇将被编码与旋翼相互作用分析系统。项目目标包括：1）确定在临终关怀的三个关键领域内，在家庭临终关怀访视过程中，护士与护理人员沟通的总体变化轨迹; 2）确定预测护士与护理人员沟通变化轨迹变化的患者、护理人员和护士因素; 3）量化护理人员和护理人员在家访过程中沟通相互依赖程度的变化如何决定护理人员的结果。研究结果将产生新的知识，护士和家庭护理人员之间的沟通，关于生命结束的沟通轨迹，并确定护理人员亚组，可能处于调整不良的风险。研究结果将为未来的干预措施提供信息，这些干预措施可能会改善临终沟通，并对丧亲之痛产生影响。

With healthcare increasingly moving into the home, a growing number of informal caregivers are seeking help from home hospice services for end of life cancer care. The informational, physical, and emotional concerns of caregivers are likely to vary over the course of the final stages of the patients' cancer and then as caregivers enter bereavement. A key task of the hospice RN case manager is to facilitate the management of caregiver needs by eliciting caregiver concerns. Effective communication between the nurse and the caregiver has the potential to enhance symptom management for the patient, reduce caregiver burden, and improve bereavement adjustment. Although effective communication at end-of life has been deemed critical, and is essential to optimal end of life patient care, little systematic research has been conducted on this topic. An important gap remains in our understanding of nurse-caregiver communication processes over the course of end-of-life care. During hospice care for cancer patients, nurses and caregivers develop a working/caring relationship in which the nature of their communication may vary according to the dynamic nature of the dying process. In this observational study, we will examine communication processes between the nurse and caregiver over the course of multiple home-based encounters. The project is guided by a patient-centered communication framework with a focus on key care domains (physical, psychological and spiritual) established by the National Consensus Project for Quality Palliative Care. We plan to audiotape all face-to-face encounters between nurses and spouse/partner caregivers for 300 home hospice oncology patients. All encounters will be coded with the Roter Interaction Analysis System. Project aims include: 1) To identify the overall trajectory of change in nurse-caregiver communication within three critical domains of end of life care over the course of home hospice visits; 2) To identify patient, caregiver and nurse factors that predict variability in the trajectory of change in nurse-caregiver communication; 3) To quantity how changing levels of communication interdependence between nurses and caregivers over the course of home visits determine caregiver outcomes. Findings will generate new knowledge about communication between nurses and home-based caregivers, about the trajectories of end-of-life communication, and identify caregiver subgroups that may be at-risk for poor adjustment. Results will inform future interventions that may improve end-of-life communication, as well as have implications for bereavement.