The ACTIVE Intervention to Improve Hospice Caregiver Pain Management

Summary

Principal Investigator: Debra Parker Oliver
Abstract: DESCRIPTION (provided by applicant): In congruence with the mission of NINR to promote and improve the health of individuals, families, communities, and populations and in response to the 11 additional institutes supporting the solicitation of proposals to address pain management (PA-07-282) this proposal seeks to test an intervention which will improve the perceptions of pain management by caregivers of hospice patients, resulting in improved pain control for those facing terminal illness. Following encouraging pilot testing the intervention has been named ACTIVE (Assessing Caregivers for Team Intervention through Video Encounters). This project proposes to strengthen hospice care for patients by enabling patient/family participation in hospice interdisciplinary teams through use of a commercially available video technologies. This randomized controlled trial will definitively test the effect of caregiver/patient participation in hospice interdisciplinary team meetings on the caregiver's perception of pain and the effect of changes in perception on reported patient pain. The study aims to 1) test the effectiveness of the ACTIVE intervention, specifically focusing on the changes in caregiver perceptions of pain, the effectiveness of caregiver assessment to identify individuals who will most benefit from the ACTIVE intervention, and the effect of changes in perception on severity of pain reported by the patient, 2) evaluate the cost and benefits and, 3) evaluate the potential for translation of the ACTIVE intervention into routine hospice care. The theoretical model modified from Saltz and Schaefer advocate the assessment of the organizational context, team process, team structure, and outcomes as a foundation for the intervention. This proposal randomizes 544 hospice caregivers into two groups (standard care and intervention) and uses qualitative and quantitative methods in parallel and equal status. The qualitative design includes observations of team meetings, record reviews, and interviews with staff and family members. The quantitative component uses standardized instruments to measure the outcomes of participation. If successful, the ACTIVE intervention can be easily translated into other settings, holding potential to improve pain management for all suffering chronic and terminal pain.
Funding Period: 2010-09-15 - 2014-06-30
more information: NIH RePORT

Top Publications

  1. pmc Technologies to support end-of-life care
    George Demiris
    Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA 98195 7266, USA
    Semin Oncol Nurs 27:211-7. 2011
  2. pmc Exploring the collective hospice caregiving experience
    Elaine Wittenberg-Lyles
    1 Division of Nursing Research and Education, City of Hope, Duarte, California
    J Palliat Med 17:50-5. 2014
  3. pmc Hospice caregiver depression: the evidence surrounding the greatest pain of all
    Debra Parker Oliver
    a Curtis W and Ann H Long Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
    J Soc Work End Life Palliat Care 9:256-71. 2013
  4. pmc Testing the factorial validity of scores from the caregiver pain medicine questionnaire
    David L Albright
    School of Social Work, University of Missouri, Columbia, Missouri, USA Electronic address
    J Pain Symptom Manage 48:99-109. 2014
  5. pmc Using medical words with family caregivers
    Elaine Wittenberg-Lyles
    1 Markey Cancer Center, Department of Communication, University of Kentucky, Lexington, Kentucky
    J Palliat Med 16:1135-9. 2013
  6. pmc Hospice caregivers' experiences with pain management: "I'm not a doctor, and I don't know if I helped her go faster or slower"
    Debra Parker Oliver
    Curtis W and Ann H Long Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA Electronic address
    J Pain Symptom Manage 46:846-58. 2013
  7. pmc Caregiver evaluation of the ACTIVE intervention: "it was like we were sitting at the table with everyone"
    Debra Parker Oliver
    1Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
    Am J Hosp Palliat Care 31:444-53. 2014
  8. pmc Exploring oral literacy in communication with hospice caregivers
    Elaine Wittenberg-Lyles
    Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA Department of Communication, University of Kentucky, Lexington, Kentucky, USA Electronic address
    J Pain Symptom Manage 46:731-6. 2013
  9. pmc Telehealth group interactions in the hospice setting: assessing technical quality across platforms
    George Demiris
    Biomedical and Health Informatics, School of Medicine, University of Washington, Seattle, WA 98195, USA
    Telemed J E Health 19:235-40. 2013
  10. pmc Targeting communication interventions to decrease caregiver burden
    Elaine Wittenberg-Lyles
    University of Kentucky, Markey Cancer Center and Department of Communication, Lexington, KY 40506 0509, USA
    Semin Oncol Nurs 28:262-70. 2012

Detail Information

Publications18

  1. pmc Technologies to support end-of-life care
    George Demiris
    Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA 98195 7266, USA
    Semin Oncol Nurs 27:211-7. 2011
    ..To describe the current level of utilization of informatics systems in hospice and palliative care and to discuss two projects that highlight the role of informatics applications for hospice informal caregivers...
  2. pmc Exploring the collective hospice caregiving experience
    Elaine Wittenberg-Lyles
    1 Division of Nursing Research and Education, City of Hope, Duarte, California
    J Palliat Med 17:50-5. 2014
    ..Research suggests that caregiving pairs may experience different caregiver outcomes. However, little is known about how caregiving pairs differ from solo caregivers (informal primary caregivers) on outcome measures...
  3. pmc Hospice caregiver depression: the evidence surrounding the greatest pain of all
    Debra Parker Oliver
    a Curtis W and Ann H Long Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
    J Soc Work End Life Palliat Care 9:256-71. 2013
    ..While the prevalence of depression reported in the identified studies of hospice caregivers ranges from 26-57%, few interventions specific to this population have been tested and the research methods have been only moderately rigorous. ..
  4. pmc Testing the factorial validity of scores from the caregiver pain medicine questionnaire
    David L Albright
    School of Social Work, University of Missouri, Columbia, Missouri, USA Electronic address
    J Pain Symptom Manage 48:99-109. 2014
    ..The Caregiver Pain Medicine Questionnaire is designed to measure caregiver agreement with statements regarding pain management. However, little testing has been done to determine its reliability and validity...
  5. pmc Using medical words with family caregivers
    Elaine Wittenberg-Lyles
    1 Markey Cancer Center, Department of Communication, University of Kentucky, Lexington, Kentucky
    J Palliat Med 16:1135-9. 2013
    ..Although there is poor communication about pain management between informal caregivers and hospice providers, little research has examined these interactions...
  6. pmc Hospice caregivers' experiences with pain management: "I'm not a doctor, and I don't know if I helped her go faster or slower"
    Debra Parker Oliver
    Curtis W and Ann H Long Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA Electronic address
    J Pain Symptom Manage 46:846-58. 2013
    ..Although hospice care teams create pain management strategies, it is the role of the caregiver to implement these plans...
  7. pmc Caregiver evaluation of the ACTIVE intervention: "it was like we were sitting at the table with everyone"
    Debra Parker Oliver
    1Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
    Am J Hosp Palliat Care 31:444-53. 2014
    ..Suggestions for improving the intervention included a more frequent meeting time, a need for to train hospice staff how to conduct web-based interactions, and suggestions for additional information for caregivers. ..
  8. pmc Exploring oral literacy in communication with hospice caregivers
    Elaine Wittenberg-Lyles
    Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA Department of Communication, University of Kentucky, Lexington, Kentucky, USA Electronic address
    J Pain Symptom Manage 46:731-6. 2013
    ..Low oral literacy has been identified as a barrier to pain management for informal caregivers who receive verbal instructions on pain medication and pain protocols...
  9. pmc Telehealth group interactions in the hospice setting: assessing technical quality across platforms
    George Demiris
    Biomedical and Health Informatics, School of Medicine, University of Washington, Seattle, WA 98195, USA
    Telemed J E Health 19:235-40. 2013
    ..Furthermore, it aims to compare the quality of plain old telephone service (POTS) and Web-based videoconferencing and provide recommendations for assessing video quality for telehealth group interactions...
  10. pmc Targeting communication interventions to decrease caregiver burden
    Elaine Wittenberg-Lyles
    University of Kentucky, Markey Cancer Center and Department of Communication, Lexington, KY 40506 0509, USA
    Semin Oncol Nurs 28:262-70. 2012
    ..To describe family communication patterns that give shape to four types of family caregivers: Manager, Carrier, Partner, and Loner...
  11. pmc Conducting the ACTIVE randomized trial in hospice care: keys to success
    Robin L Kruse
    Curtis W and Ann H Long Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
    Clin Trials 10:160-9. 2013
    ..Interdisciplinary team meetings conducted in hospices every 2 weeks provide an opportunity for hospice staff to communicate about pain management with informal caregivers of hospice patients...
  12. pmc Application of the VALUE communication principles in ACTIVE hospice team meetings
    Karla T Washington
    Kent School of Social Work, University of Louisville, Louisville, Kentucky 40292, USA
    J Palliat Med 16:60-6. 2013
    ....
  13. pmc Conveying empathy to hospice family caregivers: team responses to caregiver empathic communication
    Elaine Wittenberg-Lyles
    Markey Cancer Center, Department of Communication, University of Kentucky, Lexington, KY 40506 0509, USA
    Patient Educ Couns 89:31-7. 2012
    ..The goal of this study was to explore empathic communication opportunities presented by family caregivers and responses from interdisciplinary hospice team members...
  14. pmc Family caregiver participation in hospice interdisciplinary team meetings: how does it affect the nature and content of communication?
    Elaine Wittenberg-Lyles
    Markey Cancer Center and Department of Communication, University of Kentucky, Lexington, KY 40506 0509, USA
    Health Commun 28:110-8. 2013
    ..Implications for family participation in hospice team meetings are highlighted...

Research Grants30

  1. Mechanisms of Ethnic/Racial Differences in Lung Cancer Due to Cigarette Smoking
    Stephen S Hecht; Fiscal Year: 2013
    ..The unique combination of expertise in this program project forms a powerful team arguably unmatched in its ability to address mechanisms of lung cancer development in smokers from different ethnic/racial groups. ..
  2. BIOLOGY OF NEUROENDOCRINE PEPTIDES
    Marc R Montminy; Fiscal Year: 2013
    ..Specifying the contributions of the CRF family of ligands and receptors to the maintenance of homeostasis and to stress-linked allostasis may improve our ability to manage diseases, including mood and metabolic disorders ..
  3. COBRE Center for Central Nervous System Function
    Jerome N Sanes; Fiscal Year: 2013
    ..The COBRE Center will leverage the administrative resources available through the Brown Institute for Brain Science to ensure efficient operation and coordinate with other brain science research activities at Brown. ..
  4. DNA REPAIR, MUTATIONS AND CELLULAR AGING
    Jan Vijg; Fiscal Year: 2013
    ..All five projects together with the Animal and Pathology Core will jointly work on these topics, with their research plans fully integrated, yet maintaining their own, unique spheres of interest. ..
  5. The Impact of Hospice Preferred Practices on Patient Outcomes and Hospice Costs
    MELISSA DIANE ALDRIDGE; Fiscal Year: 2013
    ..Such information may guide national recommendations on best practices and will inform regulatory and professional interventions to monitor and promote higher quality, more cost effective care at the end of life in the hospice setting. ..
  6. Reducing disability via a bundled bio-behavioral-environmental approach
    Sarah L Szanton; Fiscal Year: 2013
    ..05) in an intention to treat analysis. The innovative study will provide economic evidence for a theory-driven intervention that could rein in costs of a growing and increasingly diverse older adult population. ..
  7. Hopkins Center for Eliminate Cardiovascular Health Disparities
    Lisa A Cooper; Fiscal Year: 2013
    ..abstract_text> ..
  8. IL-13 and IL-17 dynamics in the asthmatic airway
    Dean Sheppard; Fiscal Year: 2013
    ..RELEVANCE: Epithelial cells line the airways and play an important role in asthma. Micro-RNAs regulate gene expression. We will identify the nature, causes and consequences of changes in airway epithelial cell micro-RNAs in asthma. ..
  9. Early Phase Psychosis: Informing Treatment Decisions
    John M Kane; Fiscal Year: 2013
    ..Our ability to intervene appropriately, effectively and consistently in this population can have profound long-term public health consequences. ..
  10. Notch-Mediated Expansion of Cord Blood Progenitors for Stem Cell Transplant
    Colleen Delaney; Fiscal Year: 2013
    ..Our goal is to now determine the clinical efficacy of this approach in a phase II clinical trial. ..
  11. Caregiver Outlook: An Intervention to Improve Caregiving in Serious Illness
    Karen E Steinhauser; Fiscal Year: 2013
    ....