Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Department of Health Behavior, Society, and Policy, Rutgers University School of Public Heath, Piscataway, New Jersey.
J Palliat Med. 2019 Nov;22(11):1394-1400. doi: 10.1089/jpm.2019.0078. Epub 2019 Jun 25.
Care teams are increasingly expected to attend to the needs of patient's personal caregivers (e.g., family members). Improving communication among oncologists, patients with advanced cancer, and their personal caregivers might enhance caregivers' experiences of end-of-life (EoL) cancer care and bereavement outcomes. To explore the effects of the Values and Options in Cancer Care intervention on caregivers' experiences of EoL care and bereavement outcomes. We developed a brief behavioral intervention to improve communication among oncologists, patients with advanced cancer, and their personal caregivers. The intervention was designed to help patients/caregivers ask questions, express concerns, and help oncologists respond effectively. We randomly assigned oncologists (and their patients/caregivers) to the intervention or usual care. Medical oncologists in NY and CA; patients/personal caregivers with advanced cancer. Two months after the patient's death, caregivers completed three instruments assessing their experiences of EoL care. Seven months after the patient's death, caregivers completed the Prolonged Grief Disorder-13 (PG-13; primary prespecified outcome), the Purpose-in-Life scale, and scales assessing mental health function, depression, and anxiety. The intervention did not significantly improve caregivers' scores on the PG-13 ( = 0.21), mental health function, depression, or anxiety, but it did improve purpose-in-life scores ( = 0.018). Cohen's (95% confidence interval) for all three experiences of EoL care outcomes were promising, ranging from 0.22 (-0.19 to 0.63) to 0.39 (-0.07 to 0.86) although none was statistically significant. Preliminary findings show promise that scalable interventions in cancer care settings may improve caregiver experiences with cancer care and some bereavement outcomes.
护理团队越来越需要关注患者个人护理者(例如,家庭成员)的需求。改善肿瘤学家、晚期癌症患者及其个人护理者之间的沟通,可能会改善护理者在临终关怀和丧亲方面的体验和结果。探讨癌症护理价值观和选择干预措施对护理者临终关怀体验和丧亲结果的影响。我们开发了一个简短的行为干预措施,以改善肿瘤学家、晚期癌症患者及其个人护理者之间的沟通。该干预措施旨在帮助患者/护理者提出问题、表达关切,并帮助肿瘤学家做出有效回应。我们将肿瘤学家(及其患者/护理者)随机分配到干预组或常规护理组。纽约和加利福尼亚的医学肿瘤学家;患有晚期癌症的患者/个人护理者。在患者死亡后两个月,护理者完成了三份评估临终关怀体验的工具。在患者死亡后七个月,护理者完成了延长悲伤障碍 13 项量表(PG-13;主要预先指定的结果)、生活目的量表以及评估心理健康功能、抑郁和焦虑的量表。干预措施并未显著改善护理者在 PG-13 上的评分( = 0.21)、心理健康功能、抑郁或焦虑,但确实提高了生活目的评分( = 0.018)。所有三种临终关怀体验的 Cohen's (95%置信区间)都很有希望,范围从 0.22(-0.19 至 0.63)到 0.39(-0.07 至 0.86),尽管没有一个具有统计学意义。初步研究结果表明,癌症护理环境中的可扩展干预措施可能会改善护理者的癌症护理体验和一些丧亲结果。