A communication-based intervention for advanced cancer patient-caregiver dyads to increase engagement in advance care planning and reduce caregiver burden

项目摘要 准确的预后理解是患者参与预先护理计划的关键预测因素 (ACP)在生命的最后阶段接受更少的徒劳的、侵略性的护理。然而，大约一半的先进 癌症患者不了解他们疾病的晚期性质。护理人员在以下方面发挥着不可或缺的作用： 在生命的最后阶段，患者的护理和决策，但很少有干预措施包括他们。沈医生和 Trevino与他们的合作研究者Prigerson博士和Macievinski博士合作的试点工作表明， 改善患者和护理人员对患者终末状态的预后理解， 估计寿命与参与非加太国家方案的比率较高有关。根据这项试点工作， 照顾者在临终癌症护理中的重要作用，本研究旨在建立一种沟通机制， 基于干预，以提高晚期癌症患者和照顾者的预后理解。的目标 本研究的目的是：（1）开发一种基于沟通的干预措施来改善晚期癌症患者的生活质量， 护理者使用沟通策略的预后理解（例如，确认，确认 恐惧）和苦恼管理技术（例如，深呼吸，肌肉放松）;（2）评估 在晚期癌症患者及其照顾者中进行干预的可行性和可接受性;以及（3） 测试干预对患者和护理人员预后理解的初步疗效（主要 结果）;完成DNR命令，生前遗嘱和医疗保健代理;心理困扰;沟通 质量;照顾者负担;和医疗保健利用（次要结局）。为了实现这些目标，我们将收集 晚期癌症患者及其护理人员（n=10对）和心理社会专家（n=10）的反馈， 改进和完善干预措施。接下来，我们将对n=30名患者-护理人员进行干预试验 并评估基线、干预后和三个月后的结果，以确定可行性， 可接受性，以及干预措施在改善非加太国家参与方面的初步功效， 沟通，减少痛苦和照顾者的负担，提高目标一致的护理率， 无效的积极护理率。这些结果将为未来的NIH R 01应用提供信息，以进行大规模的 干预疗效的随机临床试验（RCT）。基于抑制性学习的理论 和社会认知加工，本研究采取了新的方法整合沟通， 痛苦管理技术，以提高患者和护理人员讨论困难的EOL主题的能力 同时管理与这些话题相关的痛苦。预计这些成果将形成一个强有力的 基金会的研究计划，重点是将照顾者纳入针对先进的干预措施 癌症患者作为一种新的和创新的方式，以提高参与ACP，提高目标率， 和谐的护理，并减少无效的，积极的EOL护理的接收。

PROJECT SUMMARY Accurate prognostic understanding is a critical predictor of patients' engagement in advance care planning (ACP) and receipt of less futile, aggressive care at the end of life. However, approximately half of advanced cancer patients do not understand the terminal nature of their illness. Caregivers play an integral role in patients' care and decision-making at the end of life, yet few interventions include them. Drs. Shen and Trevino's pilot work, in collaboration with their Co-Investigators Drs. Prigerson and Maciejewski, suggests that improving both patient and caregiver prognostic understanding surrounding the patient's terminal status and estimated life expectancy is associated with higher rates of engagement in ACP. Based on this pilot work and the important role of caregivers in end-of life (EOL) cancer care, this study aims to develop a communication- based intervention to improve advanced cancer patients' and caregivers' prognostic understanding. The goals of this study are to: (1) develop a communication-based intervention to improve advanced cancer patients' and caregivers' prognostic understanding using communication strategies (e.g., acknowledgment, validation of fears) and distress management techniques (e.g., deep breathing, muscle relaxation); (2) evaluate the feasibility and acceptability of the intervention among advanced cancer patients and their caregivers; and (3) test the preliminary efficacy of the intervention on patients' and caregivers' prognostic understanding (primary outcome); completion of DNR order, living will, and health care proxy; psychological distress; communication quality; caregiver burden; and healthcare utilization (secondary outcomes). To meet these goals, we will collect feedback from advanced cancer patients and their caregivers (n=10 dyads) and psychosocial experts (n=10) to improve and refine the intervention. Next, we will pilot test the intervention with n=30 patient-caregiver dyads and assess outcomes at baseline, post-intervention, and three months later to determine the feasibility, acceptability, and preliminary efficacy of the intervention on improving engagement in ACP and communication, reducing distress and caregiver burden, improving rates of goal-concordant care, and reducing rates of futile aggressive care. These results will inform a future NIH R01 application to conduct a large-scale randomized clinical trial (RCT) of intervention efficacy. Grounded in established theories of inhibitory learning and social-cognitive processing, the present study takes the novel approach of integrating communication and distress management techniques to improve patients' and caregivers' ability to discuss difficult EOL topics while managing the distress associated with these topics. It is expected that these results will form a strong foundation for a program of research focused on integrating caregivers into interventions targeting advanced cancer patients as a novel and innovative way to improve engagement in ACP, increase rates of goal- concordant care, and reduce receipt of futile, aggressive EOL care.