A technology-enhanced model of care for transitional palliative care versus attention control for adult family caregivers in rural or medically underserved areas: study protocol for a randomized controlled trial

Trials

Cory J. Ingram¹  Ann Marie Dose²  Catherine E. Vanderboom²  Jay Mandrekar²  Diane E. Holland²  Bijan J. Borah³  Joan M. Griffin³ 

[1] Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA;Department of Health Sciences Research, Mayo Clinic, 200 First St SW, 55905, Rochester, MN, USA;Department of Health Sciences Research, Mayo Clinic, 200 First St SW, 55905, Rochester, MN, USA;The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA;

关键词: Caregiver;    Care transitions;    Hospital discharge;    Research;   

DOI  :  10.1186/s13063-020-04806-0

来源: Springer

【 摘 要 】

BackgroundTransitioning care from hospital to home is associated with risks of adverse events and poor continuity of care. These transitions are even more challenging when new approaches to care, such as palliative care, are introduced before discharge. Family caregivers (FCGs) are expected to navigate these transitions while also managing care. In addition to extensive caregiving responsibilities, FCGs often have their own health needs that can inhibit their ability to provide care. Those living in rural areas have even fewer resources to meet their self-care and caregiving needs. The purpose of this study is to test the efficacy and cost-effectiveness of an intervention to improve FCGs’ health and well-being. The intervention uses video visits to teach, guide, and counsel FCGs in rural areas during hospital-to-home transitions. The intervention is based on evidence of transitional and palliative care principles, which are individualized to improve continuity of care, provide caregiver support, enhance knowledge and skills, and attend to caregivers’ health needs. It aims to test whether usual care practices are similar to this technology-enhanced intervention in (1) caregiving skills (e.g., caregiving preparedness, communication with clinicians, and satisfaction with care), (2) FCG health outcomes (e.g., quality of life, burden, coping skills, depression), and (3) cost. We describe the rationale for targeting rural caregivers, the methods for the study and intervention, and the analysis plan to test the intervention’s effect.MethodsThe study uses a randomized controlled trial design, with FCGs assigned to the control condition or the caregiver intervention by computer-generated lists. The intervention period continues for 8 weeks after care recipients are discharged from the hospital. Data are collected at baseline, 2 weeks, 8 weeks, and 6 months. Time and monetary costs from a societal perspective are captured monthly.DiscussionThis study addresses 2 independent yet interrelated health care foci—transitional care and palliative care—by testing an intervention to extend palliative care practice and improve transition management for caregivers of seriously ill patients in rural areas. The comprehensive cost assessment will quantify the commitment and financial burden of FCGs.Trial registrationClinicalTrials.gov NCT03339271. Registered on 13 November 2017.Protocol version: 11.

【 授权许可】

CC BY