This proposal is designed to provide Dr. Randy Hebert with the training and experience to become an independent palliative care and bereavement researcher. The candidate will build upon his fellowship training in public health and medical education with mentoring from accomplished researchers including Robert Arnold, MD and Richard Schulz, PhD, as well as independent study and coursework in health communication, clinical interventions methodology, and bereavement. Dr. Hebert will have the resources of a Division of General Internal Medicine with a history of success in mentoring junior faculty and the nationally respected Comprehensive Palliative Care Program and Center for Research on Health Care. The purpose of this proposal is to develop an intervention that will improve the physical, psychological, and spiritual well-being of bereaved family caregivers. Despite often prolonged care giving, caregivers frequently do not feel prepared, or adequately forewarned, for their loved one's death. Bereaved caregivers who were not prepared for the death suffer from higher rates of anxiety, depression, and complicated grief. Lack of preparedness has been shown to be related to inadequate communication about death and dying between caregivers and the healthcare providers (HCPs) caring for the patient. Although both agree that discussing death and dying is important, caregivers and HCPs are uncomfortable discussing these issues and HCPs often do not possess the skills necessary to address caregivers' questions. A two-armed intervention will be developed to address these barriers. First, Dr. Hebert will conduct qualitative interviews with caregivers and HCPs recruited from a large and diverse inpatient palliative care service and a community-based hospice in order to develop a question prompt sheet (QPS) that encourages caregivers to ask questions about death and dying. Second, to ensure that HCPs answer caregivers' questions in a competent, sensitive manner, the candidate will obtain the opinions of a varied panel of experts to develop a handbook that will then be used to train HCPs to address caregivers' questions. Finally, in order to determine feasibility, the intervention will be pilot tested in a sample of caregivers of terminally ill patients and the HCPs caring for the patients. Dr. Hebert's clinical experience in palliative care and fellowship training in public health and medical education give him a unique perspective to develop such an intervention. This award will facilitate the candidate's transition to an independent researcher and will lead to future studies of interventions designed to improve the well-being of family caregivers.
