A Problem Solving Intervention for Hospice Caregivers

简介（由申请人提供）：摘要近年来，家庭安宁疗护的需求迅速增长。作为非正式照护者的家庭成员和朋友对于提供姑息治疗服务至关重要；然而，这一角色对照顾者本身并非没有不利影响。有充分的证据表明，在家中照顾临终者的个人的情感需求没有得到很好的照顾，而旨在向非正式临终关怀照护者提供支持的干预措施明显缺乏。在这种背景下，问题解决疗法（PST）提供了一个整体的应对过程，培养适应性情境应对和行为能力。这可以减少和防止压力生活事件对心理和身体健康的负面影响。我们提出一项随机对照试验来全面评估非正式安宁疗护照护者的PST干预。此外，我们的目标是评估干预方式（面对面与视频）如何影响其有效性。我们提出一项为期4年的随机试验研究，将安宁疗护者随机分配至标准安宁疗护加社会支持探访组（注意控制组），或标准安宁疗护加面对面解决问题干预组（干预组1），或标准安宁疗护加视频解决问题干预组（干预组2）。具体目的包括评估PST对照顾者生活质量、解决问题能力、照顾者焦虑和照顾者感知的影响。此外，我们的目标是评估PST干预的成本效益。

DESCRIPTION (provided by applicant): Abstract In recent years, the demand for home hospice care has grown rapidly. Family members and friends who act as informal caregivers are essential to the provision of palliative care services; however, this role is not without adverse effects on the caregivers themselves. It is well documented that emotional needs of individuals caring for dying persons in their home are not well attended, and interventions aiming to provide support to informal hospice caregivers are notably lacking. In this context, problem solving therapy (PST) provides an overall coping process that fosters adaptive situational coping and behavioral competence. This reduces and prevents the negative effects of stressful life events with regard to both psychological and physical well-being. We propose a randomized controlled trial to fully evaluate the PST intervention for informal hospice caregivers. Additionally, we aim to evaluate how the modality of the intervention (face to face vs video) impacts its effectiveness. We propose a 4-year randomized trial study in which hospice caregivers will be randomly assigned to a group receiving standard hospice care with the addition of social support visits (attention control group) or a group receiving standard hospice care with the addition of the problem solving intervention delivered face to face (intervention group 1) or a group receiving standard hospice care with the addition of the problem solving intervention delivered via video (intervention group 2). The specific aims include an assessment of the impact of PST on caregiver quality of life, problem solving ability, caregiver anxiety, and caregiver perceptions. Furthermore, we aim to evaluate the cost effectiveness of the PST intervention. PUBLIC HEALTH RELEVANCE: Narrative The proposed research study explores a problem solving intervention that will improve caregivers' quality of life, and cost-effective innovative tools to support its delivery. Thus, the study is highly relevant to public health as it affects the health of a continuously growing segment of our population, namely these who are called to assume the essential role of informal caregiving, and aims to demonstrate the value of a feasible and sustainable problem solving intervention for hospice caregivers.