Increasing numbers of hospice patients are admitted with heart failure as a primary diagnosis. Hospice provides comprehensive palliative care for both patients and their family members, but family caregivers often have unmet needs, even when receiving hospice care. These family caregivers are at high risk for stress- related problems related to caregiving. Heart failure can be particularly stressful for family members, due to its chronicity, associated symptoms, and trajectory to mortality. In our previous research with family caregivers of hospice patients with cancer, we have demonstrated that providing hospice family caregivers with a brief (3-session) problem-solving training program improves caregiver quality of life, and decreases caregiver burden, during the very intense caregiving period before the death of the hospice patient. In this previous research, the problem solving training program proved more effective than hospice care alone, or hospice care plus a condition that controlled for attention and emotional support provided to the caregiver. In the proposed research, we will pilot test a caregiver problem solving protocol that has been modified to fit the special needs of family caregivers of hospice patients with heart failure. We will conduct a small randomized clinical trial to determine the effect size of the HF COPE intervention for caregivers of HF patients in hospice care for selected variables including: caregiver burden, quality of life, depression and anxiety, caregiver knowledge, patient quality of life, and Dyadic ER visits and hospitalizations and also to determine effect sizes for caregivers who receive the HF COPE intervention compared to usual care. In addition, we will interview caregivers and use their feedback to further refine the intervention. The proposed study addresses a major gap in the existing literature. Despite the high prevalence of heart failure as a cause of death, and the documented negative impact of heart failure on family caregivers, we have found no existing studies evaluating the effectiveness of a family caregiver intervention for this high risk group. Since the proposed problem solving intervention is standardized and manualized, and can be administered by hospice nurses, if this intervention proves effective, it has the potential to improve the quality of life of many patients and family members facing the stress of heart failure.

Public Health Relevance

The project, which will pilot test an intervention to train caregivers in problem-solving skills and educate them on methods for improved symptom management, should lead to the following benefits: a). improvement in patient symptoms, b). subsequent improvement in patient quality of life, c). lower caregiver estimations of burden, and d). improved caregiver problem solving ability. Improvements in any of these domains have the ability to improve caregiver well-being.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Exploratory/Developmental Grants (R21)
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Nursing Science: Adults and Older Adults Study Section (NSAA)
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Aziz, Noreen M
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University of South Florida
Schools of Nursing
United States
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Zambroski, Cheryl H; Buck, Harleah; Garrison, Christopher M et al. (2014) Lessons from the field: challenges in accruing hospice heart failure patients to intervention research. J Cardiovasc Nurs 29:91-7
Wilson, Johanna; McMillan, Susan (2013) Symptoms Experienced by Heart Failure Patients in Hospice Care. J Hosp Palliat Nurs 15:13-21
Buck, Harleah G; Zambroski, Cheryl H; Garrison, Chris et al. (2013) ""Everything They Were Discussing, We Were Already Doing"": Hospice Heart Failure Caregivers Reflect on a Palliative Caregiving Intervention. J Hosp Palliat Nurs 15:218-224
McMillan, Susan C; Small, Brent J; Haley, William E et al. (2013) The COPE Intervention for Caregivers of Patients with Heart Failure: An Adapted Intervention. J Hosp Palliat Nurs 15: