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. PUBLIC HEALTH RELEVANCE: 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. The ACTIVE intervention uses low cost commercially available video technology to enable caregiver/patient participation in hospice interdisciplinary care plan meetings.