application): As a new investigator in the fourth year of her independent research career, the candidate has addressed this MRSDA application to the psychosocial geriatrics research objective of the NIA. The training phase of this application (Years 1-2) will provide supervised experiences and establish interdisciplinary collaborations in the following areas: (1) palliative care; (2) therapeutic interventions with terminal caregivers; (3) the assessment of medical decision making capacity and the legal issues involved therein; and (4) multivariate statistics for nested research designs. The purpose of the project in Years 3-5 is to develop and evaluate a two-pronged, Care Integration Team (CIT) intervention to improve communication among professional and personal caregivers for individuals receiving in-home hospice care. A two group comparison design with an embedded intrasubject comparison component will be used to test the intervention's effectiveness. The CIT intervention attempts to improve communication among the members of CIT by: (1) training registered nurses in the administration of advance care planning (ACP) interviews and the use of enhanced job structure to facilitate treatment fidelity, and (2) training personal caregivers in the use of problem solving skills.
Aim 1 assesses the efficacy of training RNs to conduct ACP interviews and use enhanced job structure to track the impact of their ACP interviews on care recipient/personal caregiver dyads.
Aim 2 measures the impact of RN-ACP interviewing on personal caregivers knowledge of advance directives and of care recipients medical treatment wishes. Personal caregivers satisfaction with the RN-ACP interview will also be assessed.
Aim 3 assesses the efficacy of the two-pronged intervention on reducing personal caregivers experience of psychological and care-related distress during in-home hospice care. Secondary aims include measuring the longitudinal impact of the intervention among Caucasian and African-American dyads on changes in personal caregiver psychosocial outcome and on care recipient quality of life. Behavioral indicators of care recipient pain and communication will be assessed through videotapes and computer-assisted direct observational procedures.
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