In this study, the effects of a comprehensive collaborative family/nurse home care protocol (FamTechCare) will be tested over time in 38 families who manage home care for an adult dependent for survival on Home Parenteral Nutrition (HPN), the infusion of nutrients through a central venous catheter.
The specific aims are to test the effects of FamTechCare over time on the life-threatening, costly problems of catheter-related infection, situational depression, and depletion of health benefits and family caregiving resources. Each family member's perception of family function and motivation for helping will be examined. The long-term goal is to reduce problems of technological home care by strengthening families' self-help capabilities and to validate a protocol that assists families to conserve their own caregiving and health benefit resources and optimize quality of life for all family members. The interventions in the FamTechCare protocol were designed to reduce health services utilization and costs by reducing infection and depression and by enhancing quality of life, family function and caregiving effectiveness and efficiency. Subjects in the study will be adult patients requiring HPN due to gastrointestinal disorders, their primary caregivers, and all family members 13 years or older (N=114). Subjects may participate regardless of gender, socioeconomic level, or ethnic background. An established, multidisciplinary research team will conduct the study in two sites, The University of Kansas, Kansas and the Cleveland Clinic, Ohio. The research design is quasi-experimental longitudinal, with data collected prior to, during and following each intervention, at the end of the protocol, and for ten months afterward. Nurses experienced in HPN care will be trained to administer the protocol interventions, while experienced home care nurses will be trained to collect data. Hypotheses to be tested relate to the impact of the protocol on subjects' infection rates, depression, family function, motivation to help, and quality of life outcomes, use of health services, and family resources. Interventions are standardized and have been pilot tested. Measures used to obtain pre- and post- intervention data have been established as sensitive, reliable, and valid in large populations of healthy and chronically ill patients, as well as in previous research with HPN patients and their caregivers. Data analyses include content analysis of narrative data, hypothesis testing, and pooled time series analysis. Data Envelopment Analysis (DEA), an econometric technique, will be used to describe each family's area of home care efficiency and provide benchmarks and counseling information in relation to caregiving costs and health service utilization. Effective and efficient family caregiving in the growing populations of families managing technological home care can result in enhanced patient condition, normalization of family life, and for society, reduced health care costs.
| Smith, Carol E; Curtas, Susan; Kleinbeck, Susan V M et al. (2003) Clinical trial of interactive and videotaped educational interventions reduce infection, reactive depression, and rehospitalizations for sepsis in patients on home parenteral nutrition. JPEN J Parenter Enteral Nutr 27:137-45 |
| Smith, Carol E; Curtas, Susan; Werkowitch, Marilyn et al. (2002) Home parenteral nutrition: does affiliation with a national support and educational organization improve patient outcomes? JPEN J Parenter Enteral Nutr 26:159-63 |
| Smith, C E; Curtas, S (1999) Research data: source of information for patient education materials. Nutrition 15:180-1 |
| Smith, C E (1999) Caregiving effectiveness in families managing complex technology at home: replication of a model. Nurs Res 48:120-8 |
