This R21 application proposes an exploratory project called Legacy Intervention Family Enactment (LIFE) to assess the efficacy of a translational palliative care intervention based on the results of Dr. Allen's career award 5 (K01AG00943) called the Legacy Project. The Legacy project demonstrated that a life-review / reminiscence intervention coupled with a creative activity improved palliative patients'sense of meaning and reduced physical symptom burden and improved palliative caregivers'levels of stress. We are proposing to move the Legacy intervention towards translation by training community-based Retired Senior Volunteers (RSVPs) to deliver the intervention to patient-caregiver dyads living in the community. The intervention group will be compared to a minimal contact control. LIFE has three primary aims:
Aim 1 : Assess the efficacy of LIFE on patients': (a) mood and emotional experience;(b) physical symptom burden;and (c) experience of personal meaning. Hypotheses: In comparison with their report at baseline and control group patients, intervention patients will report: (a) reduced symptoms of depression and greater positive affect;(b) reduced physical symptoms;and (c) greater experienced meaning.
Aim 2 : Assess the efficacy of LIFE on the primary family caregiver's: (a) care giving stress;(b) mood and emotional experience;and (c) experience of positive aspects of care giving. Hypotheses: In comparison with their report at baseline and control group caregivers, intervention caregivers will report: (a) reduced care giving stress;(b) reduced symptoms of depression and greater positive affect;and (c) more positive aspects of care giving.
Aim 3 : Assess the ability of RSVPs to deliver LIFE effectively. Hypotheses: (a) RSVPs will demonstrate knowledge of LIFE intervention treatment components via 80% retention of this information on the LIFE Knowledge test;(b) 100% of RSVPs will earn certification in the effective delivery of the LIFE intervention;and (c) RSVPs will maintain 80% accuracy in treatment delivery as reviewed by the PI. Innovative components of this study include: (1) use of a well-validated measure as an entry criterion to identify a group of palliative care patients;(2) provision of the LIFE intervention by RSVPs, potentially increasing the potential for widespread dissemination;and (3) direct involvement of the patient and the caregiver in the intervention and the assessment of positive and negative emotional outcomes. Future projects may include seeking R18 funding for a translational study geared to directly assess the cost effectiveness of and the physical and emotional benefits provided to patients and caregivers by the implementation of LIFE by RSVPs in a variety of cultures.
Finding effective, family-based interventions for palliative care patients and their family caregivers is a major community public health need. Individuals in poor health often worry that their illness is interfering with their caregiver's other responsibilities, a fear supported by significant morbidity and mortality among caregivers. Should this volunteer-driven intervention prove effective in improving physical symptoms and mood among patients while reducing care giving stress, a larger scale test of this intervention is planned (R18) to explore cost effectiveness and generalizability to other racial/ethnic groups.
| Allen, Rebecca S; Azuero, Casey B; Csikai, Ellen L et al. (2016) ""It Was Very Rewarding for Me …"": Senior Volunteers' Experiences With Implementing a Reminiscence and Creative Activity Intervention. Gerontologist 56:357-67 |
| Allen, Rebecca S; Harris, Grant M; Burgio, Louis D et al. (2014) Can senior volunteers deliver reminiscence and creative activity interventions? Results of the legacy intervention family enactment randomized controlled trial. J Pain Symptom Manage 48:590-601 |
| Harris, Grant M; Allen, Rebecca S; Dunn, Linda et al. (2013) ""Trouble won't last always"": religious coping and meaning in the stress process. Qual Health Res 23:773-81 |
