Death comes to each of us. More and more, Americans reach the end of their lives in institutions. As the cost of nursing escalates, facilities that care for the dying increasingly turn to less expensive, and often untrained, nurses aides (NAs) to provide for the needs of the dying. Quality end-of-life care represents an urgent national priority. Rural America contains not just a disproportionate share of the nation's elderly but a higher age-adjusted rate of mortality at every stage of life. Rural communities also possess unique cultural attributes that shape the experience of health care at the end of life. Having demonstrated in Phase I the feasibility of a computer-based training (CBT) program to train rural NAs in end-of-life care, Toborg Associate proposes in Phase II to fully develop a six-module CBT. Using 15 focus groups and 15 key informant interviews, staff will define the perceptions and attitudes of NAs in rural communities to issues related to the terminally ill and care at the end-of-life. At the completion of the CBT, staff will randomize NAs between experimental and a control conditions in a rigorously designed experiment and analyze data to determine the effectiveness of the firm's CBT. ? ? ?
