Reducing Racial Disparities in Advance Care Planning within Neuro-Oncology

项目摘要：在神经肿瘤学的提前护理计划中减少种族差异 医疗质量和研究机构呼吁进行研究，以改善医疗规划 少数族裔以及优先病人群体，包括那些需要临终关怀的人。 高级护理计划(ACP)涉及对患者目标的讨论和记录，不幸的是 对于来自种族和少数民族背景的患者来说，执行得很差。机场核心计划在以下方面亦特别重要 神经肿瘤学，因为患者预后不佳，经常患有进行性认知能力下降 干扰决策能力。提议的项目的中心假设是，确定种族 及时实施ACP的文化障碍将加强末梢神经的目标一致性护理。 减少临终关怀方面的种族和族裔差异。理由是机场核心工程适时进行 是为神经肿瘤患者提供目标一致的护理服务的关键组成部分。这项建议将利用 严谨的定量和定性研究方法，回答以下创新目标：1)明确 三级医疗卫生系统中当前的ACP实施模式并分析患者层面的因素 有助于确定ACP的现有时间和内容；2)确定患者和提供者的特定态度， 实施机场核心计划所涉及的障碍和其他因素；及3)找出最可行和最实际的 可实施的战略可用于应对挑战和减少在#年实施机场核心计划方面的差距 神经肿瘤科患者群体。阿黛拉·吴博士是斯坦福大学神经外科住院医师 对改善神经肿瘤和神经外科患者的临终关怀感兴趣。她想要得到 在定量和定性研究设计、方法和规划方面的严格培训 成为一名独立的外科医生兼科学家，并成为神经外科肿瘤学和姑息治疗领域的领导者 奖励和其他职业发展资金。在导师团队的密切监督下，由 全国知名的姑息治疗和实施科学专家(卡尔·洛伦茨博士)，姑息治疗和 以患者为中心的结果(丽贝卡·阿斯拉克森博士)、生物医学伦理和沟通(大卫·马格努斯博士) 和神经肿瘤学管理(Michael Lim博士)，吴博士将实现拟议的研究目标。这个 培训计划包括定期的导师会议，正式的教学课程和研讨会，以深化 了解核心研究技能吴博士将需要获得进一步的职业发展资金，并成为 一个成功的独立调查员。此外，斯坦福大学是一个备受推崇的 生物医学研究，拥有全国最古老的姑息治疗奖学金计划 斯坦福大学姑息治疗中心 卓越中心，以及斯坦福癌症中心临床繁忙的神经肿瘤学服务和门诊 中心。

Project Summary: Reducing Racial Disparities in Advance Care Planning within Neuro-Oncology The Agency for Healthcare Quality and Research has called for research that improves care planning in racial/ethnic minorities as well as priority patient populations, which includes those who require end-of-life care. Advance care planning (ACP) involves discussion and documentation of patients’ goals and is unfortunately poorly executed for patients from racial and ethnic minority backgrounds. ACP is also especially important in neuro-oncology, as patients have poor prognoses and often suffer from progressive cognitive decline interfering with decision-making capacity. The proposed project’s central hypothesis is that identifying the racial and cultural barriers to implementing timely ACP will enhance goal-concordant care in terminal neuro- oncologic disease and reduce racial and ethnic disparities in end-of-life care. The rationale is that timely ACP is a key component of goal-concordant care delivery for neuro-oncologic patients. This proposal will utilize rigorous quantitative and qualitative research methods to answer the following innovative Aims: 1) to define current ACP implementation patterns within a tertiary-care health system and analyze patient-level factors contributing to the existing timing and content of ACP; 2) to identify patient- and provider-specific attitudes, barriers and other factors involved in ACP implementation; and 3) to identify the most feasible and practically implementable strategy available for addressing challenges and reducing disparities in ACP implementation in the neuro-oncologic patient population. Dr. Adela Wu is a neurosurgery resident physician at Stanford interested in improving end-of-life care for neuro-oncologic and neurosurgical patients. She seeks to receive rigorous training in quantitative and qualitative research design, methodology, and planning necessary to become an independent surgeon-scientist and a leader in neurosurgical oncology and palliative care with K award and other career development funding. Under the close supervision of the mentorship team led by nationally-renowned experts in palliative care and implementation science (Dr. Karl Lorenz), palliative care and patient-centered outcomes (Dr. Rebecca Aslakson), biomedical ethics and communication (Dr. David Magnus) and neuro-oncology management (Dr. Michael Lim), Dr. Wu will achieve the proposed research Aims. The training plan includes regular mentorship meetings, formal didactic courses, and seminars to deepen understanding of core research skills Dr. Wu will need to earn further career development funding and become a successful, independent investigator. Furthermore, Stanford University is a highly regarded center for biomedical research, with the oldest palliative care fellowship program nationwide, t he Stanford Palliative Care Center of Excellence, and a clinically busy neuro-oncology service and outpatient clinic at the Stanford Cancer Center.