University of Pittsburgh, Pittsburgh, PA 15261, USA.
Support Care Cancer. 2012 Sep;20(9):1937-47. doi: 10.1007/s00520-011-1295-5. Epub 2011 Nov 12.
There is a paucity of research evaluating the impact of symptom management interventions on increasing family caregiver involvement in symptom management and on caregivers' emotional health. In addition, most caregiver interventions are delivered by a health care professional, which can be costly to implement in clinical practice. The purpose of this study was to determine whether, in patients with solid tumors, a nurse-delivered symptom management intervention was more effective than a coach-led intervention in increasing caregiver involvement in symptom management and improving caregivers' emotional health.
Both caregivers and care recipients were recruited for the study. Inclusion criteria for patients were ≥40 years of age, English speaking, cognitively intact, and having a diagnosis of stage III or IV tumor. Dyads were randomized to a nurse-delivered symptom management intervention (N = 88) versus the coach-led group (N = 81). Data were collected via telephone interviews at baseline, 10, and 16 weeks.
There was no significant main effect of the problem-solving intervention on symptom assistance at 10 weeks, but there were two significant interactions, between trial arm and depressive symptoms and between baseline assistance with symptoms and relationship to the patient. Caregivers with lower depressive symptoms were more likely (OR = 1.99, 95% CI = 1.45-2.76) to provide assistance at 10 weeks if they received the nurse-delivered intervention. Spousal (versus non-spouses) caregivers who provided assistance at baseline were less likely to provide assistance at 10 weeks (OR = 0.58, 95% CI 0.36-0.94). No significant trial arm effects were found on caregiver emotional health, but assistance with greater number of symptoms was associated with worse caregiver depressive symptoms (p < 0.01) and burden (impact on schedule, p < 0.01).
Findings suggest that a nurse-delivered problem-solving intervention increases family caregivers' level of assistance in symptom management for caregivers with lower levels of depressive symptoms. Data also suggest interventions focused solely on care recipient symptom management may not be effective in improving caregivers' emotional health.
评估症状管理干预措施对增加家庭照顾者参与症状管理以及照顾者情绪健康的影响的研究相对较少。此外，大多数照顾者干预措施是由医疗保健专业人员提供的，这在临床实践中实施起来可能成本高昂。本研究旨在确定在实体瘤患者中，护士提供的症状管理干预是否比教练领导的干预更能有效地增加照顾者对症状管理的参与并改善照顾者的情绪健康。
本研究招募了照顾者和被照顾者。患者的纳入标准为年龄≥40 岁、英语流利、认知正常、诊断为 III 期或 IV 期肿瘤。对患者进行随机分组，分别接受护士提供的症状管理干预（N=88）或教练领导的干预（N=81）。通过基线、10 周和 16 周的电话访谈收集数据。
在 10 周时，解决问题的干预措施对症状辅助没有显著的主要影响，但有两个显著的交互作用，分别是试验组与抑郁症状之间以及与患者关系的交互作用。抑郁症状较低的照顾者更有可能（OR=1.99，95%CI=1.45-2.76）在接受护士提供的干预后 10 周提供帮助。如果基线时提供帮助的是配偶（而非非配偶）照顾者，则他们在 10 周时提供帮助的可能性较小（OR=0.58，95%CI=0.36-0.94）。在照顾者的情绪健康方面，没有发现显著的试验组效应，但辅助症状数量的增加与照顾者的抑郁症状（p<0.01）和负担（对日程安排的影响，p<0.01）更差有关。
研究结果表明，护士提供的解决问题的干预措施可以提高低抑郁症状照顾者在症状管理方面的照顾水平。数据还表明，仅关注照顾者症状管理的干预措施可能无法有效改善照顾者的情绪健康。
