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Palliative Care for High-Grade Glioma

高级别胶质瘤的姑息治疗

基本信息

批准号：
10302641
负责人：
Rita Caroline Crooms
金额：
$ 16.92万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-01 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10302641
关键词：
Address Adult Advance Care Planning Affect Age Aging American Society of Clinical Oncology Attitude Cancer Patient Caregiver support Caregivers Caring Certification Cessation of life Clinical Communication Complex Continuity of Patient Care Development Plans Diagnosis Disease Distress Elderly Ensure Equilibrium Ethics European Family Foundations Future Geriatrics Glioma Goals Headache Health Care Costs Impaired cognition Incidence Interview K-Series Research Career Programs Knowledge Learning Life Expectancy Literature Malignant - descriptor Malignant Neoplasms Malignant neoplasm of brain Measures Medical Records Mentors Modeling Morbidity - disease rate National Comprehensive Cancer Network Nausea Neurobehavioral Manifestations Neurologic Neurologic Symptoms Nociception Oncologist Oncology Pain Palliative Care Palliative Medicine Patient Care Patients Pattern Perception Primary Brain Neoplasms Principles of law and justice Process Prognosis Provider Psychosocial Assessment and Care Qualitative Methods Qualitative Research Quality of life Randomized Controlled Trials Religion and Spirituality Research Research Methodology Research Personnel Rotation Seizures Service delivery model Services Societies Source Specialist Structure Symptoms System Time Training Vulnerable Populations Work base cancer palliative treatment cancer therapy care delivery care providers care systems career career development cohort common symptom cultural competence data registry design end of life end of life care experience falls functional decline health care delivery health care service utilization human old age (65+)implementation science improved medical specialties multidisciplinary neoplasm registry older patient palliative physical symptom preference prevent psychologic psychological symptom psychosocial satisfaction service delivery shared decision making skills social stem symptom management symptomatic improvement treatment planning

项目摘要

Brief Summary WHO Grade III and IV gliomas (high-grade glioma or HGG) are aggressive, malignant primary brain tumors that are devastating for older adult patients and caregivers due to high symptom burden, early physical and cognitive decline, caregiver support needs, and existential distress stemming from life expectancy on the order of months. Palliative care, defined by the National Quality Forum as “patient and family-centered care that optimizes quality of life by anticipating, preventing, and alleviating suffering across the continuum of a patient's illness”, is well-suited to meet the complex needs of these patients. Multiple oncological societies recommend that palliative care be integrated early (within 3 months of diagnosis) into the treatment plan of all cancer patients. Older adults have particularly high palliative care needs, in part due to shorter prognosis and decreased tolerance for standard cancer-directed therapy. Generally, palliative care needs may be addressed through a combination of primary palliative care (delivered by any front-line provider, including neuro- oncologists) and/or specialty palliative care (delivered by a provider or multidisciplinary team with advanced palliative care training and certification). The current literature suggests that patients with HGG do not have all their palliative care needs met through primary palliative care from neuro-oncologists, yet they also are not referred to specialty palliative care until they are actively dying. There is no established model for ensuring their palliative care needs are met throughout the disease course. In this proposal, I present a conceptual model of the barriers to comprehensive, timely palliative care for patients with HGG. My career goal is to improve the delivery of palliative care for older adults with HGG. In this proposal I will: 1) use qualitative methods to assess the range of knowledge, experience, and strength of preferences of older adults with HGG, their caregivers, neuro-oncologists, and palliative medicine specialists regarding the domains of palliative care and the optimal balance of primary and specialty palliative care for each domain; 2) use an existing cohort of patients with HGG from a large health delivery system to measure the extent to which services or care processes in each palliative care domain are delivered, and to analyze the associations between palliative care delivery and overall HGG health care utilization. These two projects will be combined with my career development plan, for which I have identified a team of expert mentors and advisors and am proposing coursework relating to qualitative research methods and implementation science, as well as clinical rotations and didactic learning about core concepts in geriatrics and aging research. This will set me on a path to obtain a future career development award, which is the first step on my path to becoming an independent investigator whose work improves the care of older adults with HGG.

简短的总结