Specific aims of this study are to test the effects of a nursing intervention (FamTechCare) on family caregivers'problem solving ability, participation in health care management, health status, depression, quality of life, and health care services costs. Subjects in the study will be family caregivers (n= 80) and 80 adult patients dependent for survival on Home Parenteral Nutrition (HPN) infusions due to nonmalignant gastrointestinal disorders. Recruitment is through Kansas University Hospital and its rural outreach centers. Enrollment will be staggered over the project in order to assure adequate numbers and representative gender and racial distributions. Research methods include a placebo-controlled longitudinal clinical trial design with crossover and interventions delivered by videophone nurse visits, internet-based home care algorithm guides and by peer support. Peers are family caregivers with extensive HPN experience who will be trained to mentor dyads via videophone. These FamTechCare interventions are based on extensive preliminary data and include new, innovative extensions for this study. The entire intervention was pilot- tested and found feasible and not a burden. Questionnaires and laboratory data used to obtain pre- and post-intervention data are valid, sensitive to change and reliable and were completed in an average 20 minutes during pilot testing. Data analyses will include nested linear mixed model hypothesis testing to detect effects on caregiver/patient dyads. The novel concept of nurse caring conveyed via internet is also tested. Traditional cost analysis and the, innovative Data Envelopment Analysis (DEA) will be used to describe each family's home care efficiency in relation to and health services costs. This study uses videophone and internet delivery which increases health care access and reduces health care disparities. The potential significance and the long term goals are to strengthen home caregiving skills, improve health status, quality of life and self-management of chronic illness symptoms and invasive home care treatment.
