DESCRIPTION 3 OVERALL PROGRAM CRITIQUE 3 PROGRAM LEADERSHIP 4 PROGRAM AS AN INTEGRATED EFFORT 4 COLLABORATING INSTITUTIONS 4 PROJECT AND CORE SUMMARIES OF DISCUSSION 4 ADDITIONAL REVIEW CRITERIA 6 HUMAN SUBJECTS 6 ADDITIONAL REVIEW CONSIDERATIONS 7 INDIVIDUAL PROJECTS AND CORES 8 PROJECT 1: Symptom Care by Phone for Hospice Caregiver Support and Cancer Symptom Relief (SCP-Hospice) 8 PROJECT 2: Hospice Nurse-Caregiver Communication: Implications for Caregiving and Bereavement 18 PROJECT 3: Individualized Dual Process Intervention for Bereaved Partners after Cancer Death 29 CORE A: Methods and Implementation Core 37 COMMITTEE BUDGET RECOMMENDATIONS 42 SPECIAL EMPHASIS PANEL ROSTER DESCRIPTION (provided by applicant): Combining the strengths of three interdisciplinary research teams, the goals of this program project are: 1. to advance the science of cancer end-of-life and bereavement care by exploring and intervening to improve the experience and outcomes for spouse/partner caregivers; 2. to expedite the formation of a new interdisciplinary science team from three separate programs of research, leveraging different perspectives to improve understanding and produce meaningful interventions that address the continuum of end-of-life and bereavement care; 3. to extend research questions beyond those possible through individual studies and existing research programs and; 4. to accelerate and expand the dissemination of effective end-of-life and bereavement models, methods and findings, The goals will be accomplished through implementation of three theoretically based research projects sharing one implementation core which provides the infrastructure and coordination among the projects. The first project, Symptom Care by Phone (SCP), a prospective clinical trial, will test an automated computer-based telecommunication system that assesses severity and distress from physical and psychological symptoms common at the end-of-life, sends e-mail alerts to the hospice nurse of unrelieved symptoms and provides tailored management strategies to spouse/partner caregivers based on the individual symptom pattern. 300 home hospice cancer patients age 50+ and their caregivers will be randomized to intervention or usual care. The second project, Nurse-Caregiver Communication (NCC) will begin simultaneously. It will examine communication patterns and trajectories of communication during audio taped hospice RN home visits with the 300 caregivers. These interactions will be coded with the Roter Interaction Analysis System. The third project, Individualized Dual Process Model (DPM), will test the effectiveness of an intervention to enhance coping processes and outcomes of the spouse/partner caregivers during bereavement. 160 bereaved caregivers from the SCP project will be randomly selected and assigned to one of the two DPM project groups. Additional synergistic, interdependent aims will address cross project questions and extend the depth and breadth of the analyses using both pre and post death data.