A Problem Solving Intervention for Hospice Caregivers

摘要近年来，家庭临终关怀的需求迅速增长。作为非正式照顾者的家庭成员和朋友对提供姑息治疗服务至关重要;然而，这种作用对照顾者本身也有不利影响。有充分证据表明，在家中照顾临终者的个人的情感需求没有得到很好的满足，而且明显缺乏旨在为非正式临终关怀护理人员提供支持的干预措施。在这种情况下，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。这可以减少和防止紧张的生活事件对心理和身体健康的负面影响。我们提出了一个随机对照试验，以充分评估PST干预非正式临终关怀照顾者。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，其中临终关怀照顾者将被随机分配到一组接受标准临终关怀，并增加社会支持访视（注意力控制组）或接受标准临终关怀并增加面对面提供的问题解决干预的组（干预组1）或接受标准临终关怀并添加通过视频提供的问题解决干预的组（干预组2）。具体目标包括评估PST对护理人员生活质量、解决问题能力、护理人员焦虑和护理人员感知的影响。此外，我们的目标是评估PST干预的成本效益。 公共卫生相关性：叙述拟议的研究探讨了一个解决问题的干预措施，将提高照顾者的生活质量，并具有成本效益的创新工具，以支持其交付。因此，这项研究与公共卫生高度相关，因为它影响了我们人口中不断增长的部分的健康，即那些被要求承担非正式护理的重要作用的人，旨在证明一个可行的和可持续的解决问题的干预措施对临终关怀护理人员的价值。

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.