Individuals providing end-of-life caregiving to partners with terminal cancer often begin the bereavement process with addifional sources of stress. We know that bereavement for these partners can be long-term and impact virtually every aspect of their lives but we know very little about the effectiveness of theoreticallybased interventions to enhance their coping ability and outcomes. This project is unique because we: 1) test the effectiveness of a new promising intervenfion approach based on the dual process model (DPM), 2) use an individually-tailored intervention format that can be compared to a group delivered format from another study, 3) use a sample of spouses/partners age 50+ who used hospice home services for cancer-related deaths, 4) are one of 3 interdependent projects in a P01 application that examines the transition from predeath caregiving to long-term bereavement adaptation and studies the influence of hospice RN case managers on the participants'pre- and post-death coping processes and outcomes. The DPM suggests that bereaved persons need to oscillate between two coping processes, each related to unique sources of stress. Loss-orientation refers to the management of psychoemotional aspects of loss, and restoration-orientation deals with learning new skills of daily living. Primary aims are related to testing the effectiveness of an l-DPM intervention individually delivered to 80 hospice partners bereaved from cancer-related deaths compared to 80 similar bereaved persons in a nontreatment usual care condition. Participants will be randomized into the 2 study conditions from among those in the two other POl projects. Coping and outcome measures are obtained at baseline (2 months bereaved) and immediately after the 14-week intervention, and at 8 and 14 months bereaved. Those in the l-DPM condition are expected to show greater improvement in coping and outcomes than controls or those in the DPM treatment group in our other study. Interdependent aims address relationships between predeath caregiver coping, distress, and RN-caregiver communications and post death bereavement outcomes. The primary statisfical approach will be latent growth curve analyses, augmented by a multilevel explanatory model and other standard parametric techniques.
Cancer caregivers are identified as being at considerable risk for adverse mental and physical health outcomes. Consequently, there is a significant need to develop and make readily available more effective ways to help them as they transition from end-of-life caregiving through bereavement and living as a single person. Results from this study could lead to improvements in the effectiveness of future interventions to enhance the well-being of this significant number of cancer caregivers.
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