Mechanical Circulatory Support in Patient-Caregiver Dyads: A Longitudinal Study

描述（由申请人提供）：心力衰竭（HF）是美国增长最快的心血管疾病，并且心室辅助装置（VAD）治疗正在成为晚期HF的主要治疗选择。由于VAD患者的门诊护理对于这种高风险治疗的成功至关重要，因此现行指南要求VAD患者指定一名非正式护理人员。与此同时，文献中的广泛共识表明，将维生素A与健康和生活质量（QOL）受损联系起来，这表明VAD护理人员也是一个高危人群。总之，强制性的患者-护理人员二元组合在VAD治疗中发挥着关键作用，但由于不了解VAD治疗对二元组合的影响，提供者在识别和支持具有更大不良结局风险的患者和护理人员方面的能力有限。因此，这项拟议研究的总体目标是提供VAD患者-护理人员二人组急需的定量数据，描述患者，护理人员和二人组结果随时间的变化并确定其决定因素。将进行一项前瞻性纵向队列研究，作为NINR申办的VAD患者R 01的辅助研究，以收集入组母研究的患者的相关护理人员的数据。使用二元方法，将使用多水平和多变量纵向建模：1）确定患者临床事件风险和QOL恶化的个体水平（患者和护理人员）决定因素，2）量化护理人员压力和身体健康恶化的个体水平决定因素之间的关系，3）描述VAD患者-护理人员二元组中心理症状和QOL随时间的变化。这项创新研究将是VAD患者-护理人员二元关系的第一个纵向定量研究，因此将为推进临床管理和研究提供基础数据，并更好地支持最佳的患者，护理人员和二元结局。此外，作为国家研究服务奖提案的一部分，本研究有助于将申请人发展成为一名独立且富有成效的护士科学家的长期目标，该研究计划可持续发展临床相关，可操作的知识，以解决管理和支持快速增长的风险人群VAD患者及其护理人员的关键概念和问题。为了确保申请人拥有实现这一目标所需的知识和专业知识，本提案借鉴了一个示范性跨学科团队的综合专业知识，该团队由HF、VAD和心脏病研究人员组成，他们与申请人合作，制定了全面的培训计划，包括基本掌握研究道德行为的内容和应用经验，多种分析方法，和学术传播。因此，该提案的基本成果与NINR的目标完全一致，因为它将支持下一代护理科学家的发展并加强创新，同时提供信息以促进健康，改善QOL并减少症状在不断增长的弱势患者和护理人员中。

DESCRIPTION (provided by applicant): Heart failure (HF) is the fastest growing cardiovascular disorder in the U.S., and ventricular assist device (VAD) therapy is emerging as a main therapeutic option for advanced HF. Because outpatient care of a VAD patient is critical to the success of this high-risk therapy, current guidelines require that VAD patients designate an informal caregiver. At the same time, broad consensus in the literature that associates caregiving with compromised health and quality of life (QOL) suggests that VAD caregivers are also an at-risk population. Together, mandated patient-caregiver dyads play a critical role in VAD therapy, but without knowledge of the impact of VAD therapy on the dyad, providers are limited in their ability to identify and support patients and caregivers at greater risk for poor outcomes. As such, the overall goal of this proposed research is to provide much-needed quantitative data on VAD patient-caregiver dyads, describing changes in and identifying determinants of patient, caregiver, and dyadic outcomes over time. A prospective longitudinal cohort study, ancillary to a NINR-sponsored R01 on VAD patients, will be conducted to collect data on associated caregivers of patients enrolled in the parent study. Using a dyadic approach, multilevel and multivariate longitudinal modeling will be used to: 1) identify individual-level (patient and caregiver) determinants of worse patient clinical event risk and QOL, 2) quantify the relationship between individual-level determinants of worse caregiver strain and physical health, and 3) describe change in psychological symptoms and QOL in VAD patient-caregiver dyads over time. This innovative research will be the first longitudinal, quantitative study of patient-caregiver dyads in VAD, and will therefore provide foundational data to advance clinical management and research, and better support optimal patient, caregiver, and dyadic outcomes. Additionally, as part of a National Research Service Award proposal, this study contributes to the long-term goal of developing the applicant into an independent and productive nurse-scientist with a sustainable program of research that develops clinically relevant, actionable knowledge to address critical concepts and issues in the management and support of this rapidly growing, at-risk population of VAD patients and their caregivers. In order to ensure that the applicant has the necessary knowledge and expertise to attain this goal, this proposal draws on the combined expertise of an exemplary interdisciplinary team, consisting of expert clinicians and researchers in HF, VAD, and caregiving dyads, who have, in collaboration with the applicant, developed a comprehensive training plan that includes essential mastery of content and applied experience in the ethical conduct of research, multiple analytic approaches, and scholarly dissemination. The fundamental outcomes of this proposal are therefore well-aligned with the goals of the NINR, in that it will support the development the next generation of nurse scientists and enhance innovation, while concurrently providing information to promote health, improve QOL, and reduce symptoms in a growing and vulnerable population of patients and caregivers.