This project will implement a Simultaneous Care Educational Intervention (SCEI) for patients and caregivers and evaluate related outcome variables in three cancer centers. The project has four aims and ten objectives.
Aim 1 includes the implementation phase of the proposal and evaluates process outcomes that will guide future dissemination of the SCEI into the nation?s cancer centers.
Aim 2 involves measurement of the impact of the intervention on patients.
Aim 3 is the measurement of effect of the SCEI on families.
Aim 4 addresses the dissemination of results of the SCEI and implementation in other cancer treatment settings.
The specific aims will be accomplished using a quasiexperimental design with repeated measures. The assessments will be obtained using two pre-education measures, and assessments every thirty days for six months. The assessment points following the intervention will provide data regarding the effectiveness of the educational intervention on patients and family caregivers outcomes. The SCEI uses the COPE model (Creativity, Optimism, Planning and Expert Information) developed by D?Zurilla and Nezu, as one of its key components, for cancer patients on Phase I and II clinical trials, and combined it with a structured coaching model with the patient and caregiver to reinforce the educational intervention. The SCEI teaches patients and caregivers a problem solving approach for dealing with issues and problems common with advanced disease, and sets up a system for coaching the patient and caregiver for reinforcement of the new skills. Patients and family caregivers are taught a standardized, strategic approach to problemsolving, learn and practice new communication skills and receive periodic reinforcement and guidance from staff educators. The model uses patient/family caregiver education as file vehicle to support and sustain the patient/family constellation through the clinical trial while raising critical end-of-life and palliative issues. By applying this approach to the full range of difficulties encountered in the advanced illness and clinical trials arenas, patients and families can obtain crucial services and support while simultaneously planning for and working through difficult decisions. Based on prior individual and collaborative work, the investigators anticipate that patients and family caregivers will experience reduced distress, good symptom control, and improved quality-of-life. In addition, the enhanced communication skills of both patients and caregivers will lead to earlier identification and intervention with protocol-related complications and will promote improved recruitment and retention on clinical trials, more appropriate resource utilization, and increased frequency and duration in the use of hospice/supportive care. Having introduced and evaluated the intervention, we will disseminate the findings of the SCEI implementation and evaluation by hosting a national training program for 50 cancer centers. We will also monitor implementation of SCEI by these 50 cancer centers in their own settings. A comprehensive plan for the dissemination of the model and results to community and comprehensive cancer centers with follow-up to measure durable change completes this project.
| Browner, Ilene; Carducci, Michael A (2005) Palliative chemotherapy: historical perspective, applications, and controversies. Semin Oncol 32:145-55 |
