Hospice Nurse-Caregiver Communication: Implications for Caregiving & Bereavement

随着医疗保健越来越多地进入家庭，越来越多的非正式照顾者正在寻求家庭临终关怀服务的帮助，以进行临终癌症护理。照顾者的信息、身体和情感方面的担忧可能会随着患者癌症最后阶段的进程而变化，然后随着照顾者进入丧失亲人的状态。安宁疗养院RN病例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。护士和护理者之间的有效沟通有可能加强对患者的症状管理，减轻护理者的负担，并改善丧亲适应。尽管在临终前有效的沟通被认为是至关重要的，并且对最佳临终病人护理是必不可少的，但关于这一主题的系统研究还很少。一个重要的差距仍然存在于我们对临终关怀过程中护士与护理者的沟通过程的理解上。在癌症患者的临终关怀过程中，护士和照顾者发展一种工作/护理关系，在这种关系中，他们的交流性质可能会随着死亡过程的动态性质而变化。在这项观察性研究中，我们将检查护士和照顾者之间在多次家庭相遇过程中的沟通过程。该项目由以患者为中心的沟通框架指导，重点放在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录制护士与配偶/伴侣照顾者之间的所有面对面接触的录音。所有的遭遇都将使用Roter互动分析系统进行编码。项目目标包括：1)确定家庭临终关怀过程中临终关怀三个关键领域中护士与护理者沟通变化的总体轨迹；2)确定预测护士与护理者沟通变化轨迹变化的患者、护理者和护士因素；3)量化在家访过程中护士与护理者之间不断变化的沟通相互依赖程度如何决定护理者结局。这些发现将产生关于护士和居家照顾者之间沟通的新知识，关于临终沟通的轨迹，并确定可能面临不良适应风险的照顾者亚群。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.