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Debra Parker-Oliver, PhD, says the videophone shown could enhance communication among caregivers and hospice staff. Her study is funded by a new $2.1 million grant from the National Institutes of Health.

Better Caregiver Communication Could Minimize Hospice Patient Pain

MU researcher awarded $2.1 million grant to test improved technology and teamwork

For more than a million patients who receive hospice care each year, improved communication among caregivers and hospice staff could mean less pain during the final days of life. This is what a pilot study by Debra Parker-Oliver, PhD, has suggested, and what a new $2.1 million grant from the National Institutes of Health will allow her to thoroughly research over the next four years.

"The whole idea is that we involve the caregivers and educate them, because they are who care for the patient every single day," said Parker-Oliver, an associate professor of family and community medicine. "We'll train them to become a part of the hospice team."

Parker-Oliver's new randomized controlled trial will involve 544 hospice caregivers and three longstanding hospice programs in the state of Missouri. Researchers will observe the impact of caregivers and patients' participation in hospice meetings on the caregivers' perception of pain management, and how caregivers' perceptual changes influence patients' reported levels of pain.

"Throughout our lives, we're taught that strong drugs like morphine are bad, and that we should be careful not to give too much or people will become addicted," Parker-Oliver said. "Perceptions such as these are often barriers to caregivers who have to administer these drugs to a loved one to help them manage pain."

Eight years ago, MU researchers embarked on this area of study by asking how they might help overcome communication barriers by involving family caregivers in hospice staff team meetings, alongside the physician, nurses and social workers supervising their loved one's care. Parker-Oliver received an MU Research Board grant and used it to buy two videophones and develop what they call an ACTIVE Intervention – Assessing Caregivers for Team Intervention via Video Encounters.

In a 2006 to 2008 pilot study funded by the National Cancer Institute, Parker-Oliver tested the ACTIVE Intervention. Researchers used the commercially available phones to connect a small group of family caregivers with their hospice care teams 45 minutes to an hour away. The caregivers could see a small image of the team, and on the other end at the hospice office, staff members could see a larger image of the caregiver projected onto a large television screen.

Researchers measured caregivers' perceptions of pain management at the patients' admission to hospice and then monitored their interactions during the care team meeting every two weeks.

"Our small study showed that it doesn't take a lot of exposure to that care team to make a difference," Parker-Oliver said. "It's almost magical when care providers and patients see that there's an entire roomful of people taking care of them, even though they might feel quite alone in their home."

While the pilot study helped collect preliminary data, Oliver said the purpose of this larger study is threefold.

"We want to be able to definitively say that when caregivers are involved in the hospice team meeting, it does improve patient pain, and that using the videoconferencing equipment is cost-effective and that its feasible for hospice programs to do," Parker-Oliver said. "Our goal is that we've found a way to empower caregivers to participate in the care planning of hospice patients and improve pain management for patients."

The new research also expands upon earlier study methods, allowing caregivers the option to connect with hospice personnel using a videophone or Web camera and secure videoconferencing site.

Along with Parker-Oliver as lead investigator, the telehospice study draws on the expertise of a multidisciplinary team of researchers. MU co-investigators include Robin Kruse, PhD, associate professor of family and community medicine; Marilyn Rantz, PhD, Curators' Professor at the Sinclair School of Nursing and Helen E. Nahm Chair; and Paul Tatum, MD, assistant professor of family and community medicine. Other co-investigators include George Demiris, PhD, an associate professor of biobehavioral nursing and health systems at the University of Washington, and Elaine Wittenberg Lyles, PhD, an associate professor of communication studies at the University of North Texas.
MU Health Magazine


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