School of Allied Health, University of Western Australia, Perth, Western Australia, Australia.
Western Australia Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.
JAMA Netw Open. 2024 Oct 1;7(10):e2441019. doi: 10.1001/jamanetworkopen.2024.41019.
Informal caregivers who provide home-based care frequently experience stress and burden that adversely affect their health-related quality of life (HRQOL).
To evaluate the efficacy of the Further Enabling Care at Home (FECH+) program for the HRQOL of caregivers of older adults discharged home from the hospital.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter, parallel, 2-group randomized clinical trial, with blinded baseline and outcome measurements, was conducted at 3 hospitals in 2 states in Australia. Recruitment took place between August 2020 and July 2022, and follow-up was performed for 12 months after hospital discharge. Participants were dyads of caregivers and patients. Eligible caregivers were aged 18 years or older who provided informal home-based care at least weekly for a patient aged 70 years or older. Caregivers were enrolled when their patient was discharged from the hospital. Dyads were randomly assigned to either the intervention or control group. Data analysis followed an intention-to-treat approach.
Caregivers in the intervention group received the FECH+ program, structured nurse support of 6 telephone calls over 6 months after the patient's discharge plus usual discharge care. Caregivers in the control group received usual care alone.
Primary outcome was caregivers' HRQOL 6 months after discharge, which was measured using the Assessment of Quality of Life 8-Dimension (AQOL-8D). Secondary outcomes were caregivers' HRQOL 12 months after discharge as well as preparedness to care (measured using the Preparedness for Caregiving Scale), self-efficacy (measured using the Caregiver Inventory), and levels of strain and distress (measured using the Family Appraisal of Caregiving Questionnaire) at 6 and 12 months after discharge. Baseline and outcome measurements were administered by telephone at 3, 6, and 12 months after discharge.
A total of 547 dyads (caregivers: 405 females [74.0%], mean [SD] age, 64.50 [12.82] years; patients: 296 females [54.1%], mean [SD] age, 83.16 [7.04] years for the intervention group and 83.45 [7.20] years for the control group) were included in the intention-to-treat analysis. There was no significant difference in caregivers' HRQOL between the 2 groups at the primary time point of 6 months (difference in AQOL-8D score, 0.01; 95% CI, -0.02 to 0.03; P = .62) after hospital discharge.
In this randomized clinical trial, the FECH+ program-a nurse telephone support intervention for caregivers of older adults after hospital discharge-did not significantly improve caregivers' HRQOL at 6 months after discharge compared with usual care. Additional examination is warranted into improving caregivers' HRQOL at the time of their patient's hospital discharge.
Australian New Zealand Clinical Trials Registry Identifier: ACTRN12620000060943.
提供家庭护理的非正式护理人员经常会经历压力和负担，这会对他们的健康相关生活质量（HRQOL）产生不利影响。
评估进一步加强家庭护理（FECH+）计划对从医院出院的老年患者护理人员 HRQOL 的疗效。
设计、地点和参与者：这是一项多中心、平行、2 组随机临床试验，具有盲法基线和结果测量，在澳大利亚 2 个州的 3 家医院进行。招募工作于 2020 年 8 月至 2022 年 7 月进行，出院后进行了 12 个月的随访。参与者是护理人员和患者的二人组。符合条件的护理人员年龄在 18 岁或以上，每周至少为 70 岁或以上的患者提供非正规家庭护理。当患者从医院出院时，护理人员即可入组。二人组随机分配到干预组或对照组。数据分析遵循意向治疗方法。
干预组的护理人员接受了 FECH+计划，即 6 个月内进行 6 次电话护士支持，外加常规出院护理。对照组的护理人员仅接受常规护理。
主要结果是出院后 6 个月护理人员的 HRQOL，使用 8 维度生活质量评估（AQOL-8D）进行测量。次要结果是出院后 12 个月护理人员的 HRQOL 以及护理准备情况（使用护理准备量表测量）、自我效能（使用护理人员清单测量）以及出院后 6 个月和 12 个月的压力和困扰水平（使用家庭评估量表测量）。出院后 3、6 和 12 个月通过电话进行基线和结果测量。
共有 547 对（护理人员：405 名女性[74.0%]，平均[SD]年龄，64.50 [12.82] 岁；患者：296 名女性[54.1%]，平均[SD]年龄，83.16 [7.04] 岁）被纳入意向治疗分析。出院后主要时间点（6 个月），两组护理人员的 HRQOL 无显著差异（AQOL-8D 评分差异，0.01；95%CI，-0.02 至 0.03；P=0.62）。
在这项随机临床试验中，FECH+计划——出院后老年患者护理人员的护士电话支持干预——与常规护理相比，在出院后 6 个月时并未显著提高护理人员的 HRQOL。需要进一步研究如何在患者出院时提高护理人员的 HRQOL。
澳大利亚和新西兰临床试验注册中心标识符：ACTRN12620000060943。
