BACKGROUND/RATIONALE:
Of the 65 million Americans who serve as informal caregivers of persons with chronic disability or illness, about 5.5 million are caring for Veterans. These caregivers play a significant role in helping to maintain the health and well-being of Veterans and often experience significant burden related to their caregiving role, including poor physical health, financial difficulties, and low confidence in the care they provide. Current VA programs aim to improve caregivers' knowledge and ability to provide direct care at home to patients with dementia, TBI, cancer, and stroke. However, these programs have a number of limitations. First, they are not always able to respond to caregivers' social and practical needs adequately. Second, caregivers of seriously ill Veterans age 65 and older living in the community, an age group with high risk for unmet needs secondary to chronic illness and impairment, may not always get needed services due to an emphasis on post 9/11 Veterans and their caregivers. Third, they do not focus specifically on helping caregivers to navigate existing resources to meet their social and practical needs.

OBJECTIVE(S):
Based on evidence of their effectiveness in other settings, health navigator programs may help address unmet social and practical needs of caregivers and reduce caregiver burden by providing direct linkages to services and other resources. This CDA proposes to develop a novel, effective navigator intervention targeting caregivers of older, community-dwelling Veterans with advanced illness. In prior work, patient navigation programs have facilitated cancer screening, clinical follow-up, advance care planning, psychosocial support, and care coordination. The central hypothesis is that a novel adaptation of established models of navigation can improve the ability of caregivers to care for older Veterans with advanced illness (cancer, COPD, or CHF) if it is: 1) informed by caregivers and patients themselves along with other VA and community stakeholders; and 2) focused on identifying and supporting social support and practical needs using both VA and community resources.

METHODS:
To evaluate this hypothesis, three complementary, but distinct specific aims are proposed: (Aim 1) Assess social and practical needs of caregivers of older (age 65 and older) community-dwelling Veterans with advanced illness and their preferences for intervention. This aim will include prospectively conducted key-informant interviews with seriously ill Veterans and caregivers coupled with input from a Stakeholder Advisory Board which includes Veterans, caregivers, VA providers, and community organization membership (e.g., Area Agency on Aging); (Aim 2) Using data from Aim 1, develop a curriculum to train navigators to identify caregiver needs and link them to resources within VA and their community to address those needs; and (Aim 3). In a pilot study, assess feasibility and acceptability of a caregiver navigator intervention in meeting the social and practical needs of caregivers of community-dwelling older veterans with advanced illness by increasing knowledge of and access to services and resources.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The findings of this study will lead to a novel intervention which may significantly reduce caregiver burden and, in so doing, improve the care of community dwelling veterans with advanced illness. This is consistent with VA's Health Services Research and Development priority of improving caregiving and long- term care in service to Veterans.

PUBLICATIONS:

Journal Articles

1. Boucher NA, Tucker MC, White BS, Ear B, Dubey M, Byrd KG, Williams JW, Gierisch JM. Frontline Clinician Appraisement of Research Engagement: "I feel out of touch with research". Journal of general internal medicine. 2023 Sep 1; 38(12):2671-2677.
2. Sperber NR, Shapiro A, Boucher NA, Decosimo KP, Shepherd-Banigan M, Whitfield C, Hastings SN, Van Houtven CH. Developing a person-centered, population based measure of "home time": Perspectives of older patients and unpaid caregivers. Healthcare (Amsterdam, Netherlands). 2021 Dec 1; 9(4):100591.
3. Boucher NA, Zullig LL, Shepherd-Banigan M, Decosimo KP, Dadolf J, Choate A, Mahanna EP, Sperber NR, Wang V, Allen KA, Hastings SN, Van Houtven CH. Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design. BMC health services research. 2021 May 6; 21(1):430.
4. Santoki A, Boucher N. Investigating Barriers to Vaccination Among Durham County's Vulnerable Populations. North Carolina Medical Journal. 2021 May 1; 82(3):164-170.
5. Dawson WD, Boucher NA, Stone R, VAN Houtven CH. COVID-19: The Time for Collaboration Between Long-Term Services and Supports, Health Care Systems, and Public Health Is Now. The Milbank Quarterly. 2021 Jun 1; 99(2):565-594.
6. Boucher NA. No Hugs Allowed: Isolation and Inequity in North Carolina Long-term Services and Supports During COVID-19. North Carolina Medical Journal. 2021 Jan 1; 82(1):57-61.
7. Gray NA, Boucher NA, Cervantes L, Berlinger N, Smith SK, Johnson KS. Hospice Access and Scope of Services for Undocumented Immigrants: A Clinician Survey. Journal of palliative medicine. 2021 Aug 1; 24(8):1167-1173.
8. Boucher NA, Van Houtven CH, Dawson WD. Older Adults Post-Incarceration: Restructuring Long-term Services and Supports in the Time of COVID-19. Journal of The American Medical Directors Association. 2021 Mar 1; 22(3):504-509.
9. Boucher NA, Johnson KS. Cultivating Cultural Competence: How Are Hospice Staff Being Educated to Engage Racially and Ethnically Diverse Patients? The American journal of hospice & palliative care. 2021 Feb 1; 38(2):169-174.
10. Boucher NA, Shepherd-Banigan M, McKenna K, Delgado RE, Peacock K, Van Houtven CH, Van Noord M, Sperber NR. Inclusion of Caregivers in Veterans' Care: A Critical Literature Review. Medical care research and review : MCRR. 2021 Oct 1; 78(5):463-474.
11. Koenig HG, Youssef NA, Smothers Z, Oliver JP, Boucher NA, Ames D, Volk F, Teng EJ, Haynes K. Hope, Religiosity, and Mental Health in U.S. Veterans and Active Duty Military with PTSD Symptoms. Military medicine. 2020 Feb 12; 185(1-2):97-104.
12. Boucher NA, Van Houtven CH. A Day in the Life during COVID-19: Long-term Care Providers in Durham, North Carolina. The Permanente journal. 2020 Jan 1; 24.
13. Shepherd-Banigan M, Kaufman BG, Decosimo K, Dadolf J, Boucher NA, Mahanna EP, Bruening R, Sullivan C, Wang V, Hastings SN, Allen KD, Sperber N, Coffman CJ, Van Houtven CH. Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing. 2020 Jan 1; 52(1):23-33.
14. Sperber NR, Boucher NA, Delgado R, Shepherd-Banigan ME, McKenna K, Moore M, Barrett R, Kabat M, Van Houtven CH. Including Family Caregivers In Seriously Ill Veterans' Care: A Mixed-Methods Study. Health affairs (Project Hope). 2019 Jun 1; 38(6):957-963.

DRA: Other Conditions, Health Systems
DRE: TRL - Development
Keywords: none
MeSH Terms: none