Patients with head and neck, lung, esophageal, rectal and anal cancers typically undergo rigorous, intense treatment, usually including some combination of radiation, surgery and chemotherapy.
Much of a patient's care occurs in the home, and family members often help them manage symptoms and assist with physical needs. But family caregivers say they don't feel prepared to tackle such tasks as tube feedings, wound and colostomy care, pain management and ongoing emotional support.
With a $2.14 million grant from the National Cancer Institute (NCI), researchers from the Frances Payne Bolton School of Nursing at Case Western Reserve University will measure whether an approach that uses simulation or experiential learning can affectively teach family caregivers not only the skills to take better care of their patient, but better care of their own emotional and physical health amid such incredible stress.
In today's health-care system, there is a critical need to support and better prepare family caregivers of patients with cancer for the pivotal role they play in attaining positive outcomes during rigorous treatment, said Susan Mazanec, an assistant professor at the nursing school and a member of the Cancer Prevention Control and Population Research Program at the Case Comprehensive Cancer Center (CCCC), who is leading the study.
"We know that simulation is effective in training health-care professionals, but little is known about its effectiveness in training family caregivers," she said. "The intervention is designed for the period of active cancer treatment and immediate posttreatment--a time when the caregiver and patient are most vulnerable."
Researchers will recruit 180 family caregivers of patients from University Hospitals Seidman Cancer Center in Cleveland, where Mazanec is also a nurse scientist. Half of the caregivers will be involved in the intervention; the other half will not, so results of the two groups can be compared.
The intervention, which was designed with oncology clinicians at CCCC, involves three one-on-one sessions between the caregiver and an intervention nurse during a patient's radiation treatments, followed by a telephone contact two weeks post-treatment.
Sessions will address understanding the disease and what the patient is experiencing, caregiver self-care and common issues after cancer treatment. In addition, simulation experiences that involve working with mannequins or role-play scenarios will be used to allow caregivers to practice technical and communication skills.
The goals are to improve caregiver physical and emotional well-being, increase confidence for caregiving and improve patient outcomes for health-related quality of life and care during treatment. More specifically, researchers hope to:
- Evaluate the effect of the intervention approach on a caregiver's anxiety, depression, health-related quality of life and fatigue;
- Measure the intervention's effect on patient outcomes, such as unplanned hospital admissions and emergency room visits and unplanned use of intravenous fluids;
- Determine if caregivers' self-efficacy mediates the effect of the intervention on their anxiety;
- Determine if patient illness factors, care demands and patient and caregiver demographic factors moderate the relationship between the intervention and caregiver outcomes;
- And compare the health-care costs of the intervention and control groups.
The research was supported by the National Cancer Institute of the National Institutes of Health (NIH) (award number R37CA240707). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.
The study addresses NCI's Division of Cancer Control and Population Sciences mission of improving the delivery of care to individuals and family members affected by cancer. The findings will provide crucial information for translating the psychoeducational and simulation methods used in the intervention to other caregiver populations and clinical settings.
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