James R. Zabora - US grants

DESCRIPTION (Applicant's Description) The specific aims of this application are to: 1. Investigate the effect of a problem-solving educational intervention for family caregivers of cancer patients on problem-solving skills and psychological well-being of family caregivers, and secondarily, of patients; 2. Examine the differential effect of the problem-solving intervention on psychological well-being and problem-solving behaviors in families whose level of functioning is balanced or extreme with the goal of identifying hypotheses for future research. The effects of cancer reverberate throughout the family. Cancer generates demands that impose severe levels of stress that can challenge even the most well-functioning family. Most importantly, these struggles occur as families attempt to serve as the primary source of support for the patient - a buffer against stress and a facilitator for effective decision-making and problem- solving. In addition, dramatic changes in health care delivery have significantly increased the expectations of health care providers on families as caregivers. Consequently, an imperative in cancer has emerged to develop new and effective ways to enhance the problem-solving abilities of family caregivers. This study will investigate the effect of a problem-solving educational intervention for use with family caregivers of cancer patients under active treatment or during a discharge from an acute hospitalization. Thirty (30) family caregivers of patients initiating radiotherapy and an additional thirty (30) family caregivers of patients acutely hospitalized will be recruited for this study. A quasi-experimental design with "time-series" assessments will be employed to demonstrate that the dependent measures of problem-solving behavior and psychological well-being are stable prior to the intervention due to the lack of a control group. Following the intervention, assessments will occur at 30 days and again at 60 days to determine the effect of the problem- solving educational program through paired t-tests and MANOVA. A critical analysis will examine family functioning, i.e., balanced versus extreme, as an influence on the changes in the family caregiver's problem-solving behavior over the course of the study.

Pain management is critical throughout cancer care, from diagnosis through treatment and survivorship, and in advanced illness and at the end of life. Improving cancer pain management is critical over the next decade, given (1) more number of cancer survivors with long-term consequences of cancer and its treatment, (2) longer survival with advanced cancer, with more time with and complexity of pain, and (3) growing evidence that chronic opioids are often ineffective and have many adverse effects and risks. Cancer pain is often challenging; it interacts with many issues, including psychological and social concerns and other symptoms, especially fatigue and sleep disturbances. Severe cancer pain is still frequent in the United States; the quality of pain management is often suboptimal; key effective nonpharmacologic strategies, such as rehabilitation, and psychosocial approaches, such as patient education and support, are underused; and disparities in management persist. A key solution, using a biopsychosocial approach, considers not only biological aspects, but other related symptoms and interactions with psychological (e.g., distress, mood) and social (e.g., culture, family, financial stressors) factors. The effectiveness of biopsychosocial approaches is well-established, but improving use in cancer care requires both interdisciplinary health professional education and quality improvement approaches. This education program is based on the extensive health professional education programs at Johns Hopkins Bloomberg School of Public Health and Medicine and supportive oncology education programs of the City of Hope. The overall goal is to improve US capacity for biopsychosocial cancer pain management. To accomplish this, we will train 360 cancer care professionals (physicians, nurses, social workers and others) over the award. In a 15-week program, participants will participate in 8 webinars, an online simulation program, a 2-day intensive skills-based workshop, and 2 pre-workshop preparatory and 4 post- workshop implementation faculty-participant conference calls. The aims are to (1) implement a curriculum for training healthcare professionals in principles of biopsychosocial cancer pain management and quality improvement, (2) sustain and refine newly acquired pain management and quality improvement skills through ongoing support and building a networking community, and (3) assess the effectiveness of the education after the program and sustainability at one year. An expert team of faculty, advisors and patient advocates will plan, produce, and evaluate the program, including experts in professional and executive education, pain management and associated issues and symptoms, skills-based supportive oncology education and quality of care. The Principal Investigators have combined decades of experience in educating health professionals in biopsychosocial pain management and program development. We have support from local and national cancer networks and organizations to recruit a diverse, qualified participant pool and support implementation into practice, with the goal of improving patient care and outcomes.