The increase in the prevalence of cancer and the trend toward early discharge from the hospital means that more patients with complex health needs will be cared for in the home setting. In Montana, health care issues are complicated by geographic isolation, demographics of a sparsely populated state, and limited home care services. This study will describe in detail the current patterns of home care of cancer patients in Montana. Home care needs, the adequacy of care received, and the effect of the illness on individuals and the family unit will be analyzed with the following objectives: a) document the current care of cancer patients who are managed in the home; b) examine changes in home health care needs of cancer patients over time; c) test the stress buffering mechanisms of perceived social support on family and individual functioning; d) identify contributions of the family to the home care of cancer patients and the impact of these contributions on family well-being; e) determine the relative impact of disease, personal, and community characteristics on the patient, the caregivers, and the well-being of the family; f) develop valid, reliable, and sensitive measures of the adequacy of home health care services and home care needs to be used in both research and clinical arenas. The research program will be a three-year longitudinal investigation. Individuals in Montana with a diagnosis of cancer will be identified through physicians, treatment centers and home health care agencies, and public media announcements. The individual with cancer, their spouse or primary care provided, and home health care agencies will be surveyed using mail questionnaires and personal interviews and data will be analyzed using multivariate techniques. Focus group techniques with health care providers and cancer patients will used to develop questionnaire items specific to the home care of persons in rural areas. A small group of families will be interviewed to evaluate the validity of the survey instruments. The focus of the interviews will be to probe further for information about the responses provided on the survey and to explore additional issues that may surround the patient's ability to remain at home with their disease. This study will provide data for planning intervention strategies for optimal home care of cancer patients and their families in Montana and other rural western states.
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