A Psychosocial Intervention for the Caregivers of Advanced Lung Cancer Patients

描述(由申请人提供)：与晚期肺癌(LC)相关的严重症状负担使护理成为一项复杂而繁重的任务。尽管有门诊姑息护理服务的投入，LC家庭往往对护理缺乏准备，有 在家中管理症状的自我效能感低，报告的身体和情绪痛苦的比率很高，接受的技能培训或心理社会护理很少。到目前为止，少数针对晚期癌症患者照顾者的心理干预试验主要针对临终关怀患者的家属，尚未很好地融入常规姑息治疗，也没有解决LC照顾者的具体需求。基于我们在LC发表的和最近完成的试点工作，我们开发了一种名为CareSTEPS的心理社会干预措施(自我护理、压力管理、症状管理、有效沟通、问题解决和社会支持)。CareSTEPS以自我决定理论(SDT)为基础，该理论关注的是个人对 培养自主性(选择感和意志感)、能力(自我效能感)和关联感(归属感和联系感)。它：1)教授技能，以提高照顾者管理症状、实践自我护理和应对癌症的能力~2)通过为建议和鼓励选择和阐述的各种选择提供明确的理由来支持照顾者的自主性~以及3)通过教授有效沟通和寻求/接受社会支持的策略来寻求改善照顾者的关联感。我们将在治疗开始后一个月(基线)内招募200名LC患者和他们的照顾者，并将他们随机分配到常规医疗(UMC)条件或CareSTEPS干预(照顾者通过电话接受一份手册和每周六次45分钟的咨询会议)。跟踪调查在基线后8周和6个月完成。主要目的是确定CareSTEPS干预对照顾者自我护理行为、身体和情感生活质量以及护理满意度的影响。第二个目标是：1a)检验CareSTEPS对能力、自主性和关联性的SDT结构的影响；b)检验照顾者的能力、自主性和关联性是否如假设的那样中介CareSTEPS对照顾者结局的影响；2)探索社会人口、医学和关系因素是否调节CareSTEPS干预对SDT结构的影响；3)探索CareSTEPS对患者生活质量、姑息护理利用、护理满意度的影响。CareSTEPS通过为积极治疗的晚期LC患者的照顾者提供教育、技能培训和支持，填补了一个重要的服务缺口。以家庭为基础的交付形式将为今后的传播和外联提供便利。通过赋予家庭提供护理所需的技能并迎接LC的挑战，CareSTEPS为改善照顾者生活质量、患者生活质量以及晚期癌症患者及其家人的姑息/支持性护理服务质量带来了巨大的希望。

DESCRIPTION (provided by applicant): The profound symptom burden associated with advanced lung cancer (LC) makes caregiving a complex and burdensome task. Despite the input of outpatient palliative care services, LC families are often unprepared for caregiving, have low self-efficacy for managing symptoms at home, report high rates of physical and emotional distress, and receive very little skills training or psychosocial care. To date, the few psychosocil intervention trials targeting the caregivers of advanced cancer patients that have been conducted have mostly targeted the families of hospice patients, have not been well-integrated into routine palliative care, and have not addressed the specific needs of LC caregivers. Based on our published and recently completed pilot work in LC, we have developed a psychosocial intervention called CareSTEPS (self-Care, Stress management, sympTom management, Effective communication, Problem-solving, and Social support). CareSTEPS is grounded by Self Determination Theory (SDT) which focuses on individuals' needs for developing autonomy (a sense of choice and volition), competence (self-efficacy), and relatedness (a sense of belonging and connection). It: 1) teaches skills to enhance caregiver competence for managing symptoms, practicing self-care, and coping with cancer~ 2) supports caregiver autonomy by providing a clear rationale for recommendations and a variety of options to encourage choice and elaboration~ and, 3) seeks to improve caregivers' sense of relatedness by teaching strategies for effective communication and soliciting/accepting social support. We will enroll 200 LC patients within one month of treatment initiation (baseline) and their caregivers and randomize them to either a usual medical care (UMC) condition or the CareSTEPS intervention (caregivers receive a manual and six 45-minute weekly counseling sessions by telephone). Follow-up surveys are completed at 8 weeks and 6 months post-baseline. The primary aim is to determine the impact of the CareSTEPS intervention on caregiver self-care behaviors, physical and emotional QOL, and satisfaction with care. Secondary aims are to: 1a) examine the effects of CareSTEPS on the SDT constructs of competence, autonomy, and relatedness~ 1b) test whether caregiver competence, autonomy and relatedness mediate the effects of CareSTEPS on caregiver outcomes as hypothesized~ 2) explore whether sociodemographic, medical, and relationship factors moderate the effects of the CareSTEPS intervention on SDT constructs~ and, 3) explore the effects of CareSTEPS on patient QOL, palliative care utilization, nd satisfaction with care. CareSTEPS fills an important service gap by providing education, skills training, and support to the caregivers of advanced LC patients who are on active treatment. The home-based delivery format will facilitate future dissemination and outreach. By empowering families with the skills they need to provide care and meet the challenges of LC, CareSTEPS holds great promise for improving caregiver QOL, patient QOL, and the quality of palliative/supportive care services for advanced cancer patients and their families.