Discipline, Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia.
Palliat Med. 2012 Oct;26(7):917-23. doi: 10.1177/0269216311421834. Epub 2011 Sep 19.
Although the unit of care in palliative care is defined as the patient and their family, there are few rigorous studies on how to improve support for family and friends as they take on the role of caregiver for someone at the end of life.
Separate to patient evaluation and care, this pilot study aimed to define the feasibility and possible outcome measures to evaluate routine assessments and supports specifically for caregivers.
In a quasi-experimental design, two communities were included: one received standard specialist palliative care support and one additionally was allocated to a community network facilitator who assessed caregivers' needs and helped mobilize the caregiver's own support network or initiated contact with other community supports in three planned visits. Data were collected at baseline, 4 and 8 weeks using three caregiver assessment tools. Within group comparisons were made using Wilcoxon signed rank test and between group using the Mann-Whitney U-test.
Sixty-six caregivers participated.
At 8 weeks, participants in the intervention arm showed significant within-group improvement in caregiver fatigue, sufficient support from others, decreased resentment in the role, greater confidence in asking for assistance and were better able to find resources and support. No between-group changes were seen in this pilot study.
There were objective measures of improved support within the intervention group over time for caregivers through the active engagement of the community network facilitator. This pilot supports the case for an adequately powered study.
尽管姑息治疗的护理单位被定义为患者及其家属,但很少有严格的研究来探讨如何为临终患者的家属和朋友提供支持,以帮助他们承担照顾者的角色。
除了对患者进行评估和护理外,本试点研究旨在确定为照顾者进行常规评估和支持的可行性和可能的结果测量方法。
采用准实验设计,纳入两个社区:一个社区接受标准的专科姑息治疗支持,另一个社区则额外分配一名社区网络协调员,负责评估照顾者的需求,并帮助调动照顾者自己的支持网络,或在三次计划访问中与其他社区支持联系。在基线、4 周和 8 周时使用三种照顾者评估工具收集数据。使用 Wilcoxon 符号秩检验进行组内比较,使用 Mann-Whitney U 检验进行组间比较。
66 名照顾者参与了研究。
在干预组,8 周时,参与者在照顾者疲劳、他人提供的足够支持、角色怨恨感减少、寻求帮助的信心增加以及更好地寻找资源和支持方面均显示出组内显著改善。在这个试点研究中,未观察到干预组与对照组之间的变化。
通过社区网络协调员的积极参与,干预组的照顾者在支持方面有了客观的改善。这一试点研究支持了进行充分功率研究的理由。