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，以进行临终癌症护理。在病人癌症的最后阶段，照顾者的信息、身体和情感关注可能会有所不同，然后随着照顾者进入丧亲之痛。安宁疗护注册护士个案管理员的一项关键任务，是透过引起照顾者的关切，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患者的症状管理，减轻照顾者的负担，并改善丧亲之痛的调整。尽管在临终时有效的沟通被认为是至关重要的，并且对于最佳的临终患者护理至关重要，但关于这一主题的系统研究很少。一个重要的差距仍然是我们的理解护士和护理人员的沟通过程中，在临终关怀的过程中。在对癌症病人进行临终关怀期间，护士和照护者会发展出一种工作/关怀关系，在这种关系中，他们沟通的性质可能会根据死亡过程的动态性质而变化。在这项观察性研究中，我们将检查护士和看护者在多次家庭接触过程中的沟通过程。该项目以“国家优质姑息治疗共识项目”建立的以患者为中心的沟通框架为指导，重点关注关键护理领域（身体、心理和精神）。我们计划为300名家庭安宁疗护肿瘤病人录下所有护士与配偶/伴侣照护者面对面的谈话。所有的遭遇战都将用Roter互动分析系统进行编码。项目目标包括：1)确定在居家安宁疗护访视过程中，护生与照护者在临终关怀的三个关键领域内沟通变化的整体轨迹；2)识别预测护护沟通变化轨迹变异性的患者、护理者和护士因素；3)量化在家访过程中护士和护理人员之间的沟通相互依赖水平的变化如何决定护理人员的结果。研究结果将产生关于护士和家庭护理人员之间沟通的新知识，关于临终沟通的轨迹，并确定可能存在适应不良风险的护理人员亚组。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.