This proposal requests support for a five-year continuation of the principal investigator's program of research on psychosocial interventions in radiation therapy. Working with Orem's conceptual framework for nursing, the Self-Care Model of Nursing in Radiation Therapy was developed to guide the research. Specifically, the aims of this competing continuation proposal are: (1) to complete the original randomized clinical trial to determine the effects of nursing interventions on the self-care behaviors, functional health, emotional distress levels, and treatment outcomes of patients receiving a long (4-7 week) course of radiation therapy; (2) to initiate and complete a parallel randomized clinical trial of nursing interventions modified to address the needs and assess comparable outcomes for patients receiving a short (<4 weeks) course of treatment; (3) to assess the validity and reliability of a screening questionnaire as a predictor of risk for emotional distress during radiation therapy; (4) to determine the needs and concerns of the informal caregivers of patients receiving radiation therapy; and (5) to conduct a comparative study to assess the effects of a three-session group intervention on the knowledge level, health status, emotional distress, and well-being of the informal caregivers. A series of five coordinated projects are proposed to meet the specific aims. For Projects 1 and 2, patients are stratified by gender, treatment site, prior experience with radiation, and preference for information and then randomized to one of (the four aims: Informational, Behavioral, Comprehensive, or Placebo Control. Interventions are provided by clinical nurse specialists (CNS) following a sequential protocol over the course of treatment. Dependent variables are also assessed longitudinally. Project 3 involves eligible patients who cannot participate in the randomized studies due to time demands. Their prestudy responses will be compared to a posttreatment distress assessment in a double cross validation of the OSQ. Stability of responses will also be assessed. Project 4 will involve in-depth interviews with a purposive sample of informal caregivers using ethnographic methods. In Project 5, the caregivers will be randomized to receive either an Information or Comprehensive intervention provided by a CNS in three group sessions. These findings will also be compared to historical controls. Data analysis involves correlational and inferential statistical techniques.
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