Impact of the Therapeutic Alliance on Reduction of Disparities in Latino End-of-Life Cancer Care

治疗联盟对减少拉丁裔临终癌症护理差异的影响

• 批准号: 10400060
• 负责人: Ana Isabel Tergas
• 金额: $ 24.18万
• 依托单位: BECKMAN RESEARCH INSTITUTE/CITY OF HOPE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400060
• 关键词: Address; Advance Care Planning; Advanced Malignant Neoplasm; Applications Grants; Award; Behavior Therapy; Belief; Cancer Patient; Caring; Cause of Death; Client satisfaction; Collaborations; Communication; Competence; Data; Data Analyses; Development; Emotional; Empathy; Ethnic Origin; Family Caregiver; Feedback; Focus Groups; Foundations; Funding; Future; Goals; Grant; Hospitals; Human; Immigrant; Impairment; Intervention; Interview; Latino; Latino Population; Literature; Malignant Neoplasms; Measures; Medical; Mentorship; Methods; Minority Groups; Modeling; Observational Study; Oncologist; Outcome; Participant; Patients; Perception; Physicians; Provider; Psychotherapy; Quality of life; Randomized; Religion and Spirituality; Reporting; Research; Resuscitation; Self Determination; Services; Site; Terminal Disease; Theoretical model; Therapeutic; Training; Treatment Effectiveness; Treatment Efficacy; Trust; United States National Institutes of Health; acceptability and feasibility; base; behavior change; cancer care; care outcomes; career; clinical practice; cohesion; disparity reduction; effective intervention; end of life; end of life care; evidence base; expectation; experience; field study; hospice environment; implementation science; improved; patient oriented; pilot test; preference; primary outcome; prognostic; programs; prospective; secondary outcome; shared decision making; theories; therapy design; therapy development; treatment as usual

PROJECT SUMMARY This proposal aims to develop and pilot test a theoretically-grounded, behavioral intervention to promote the development of a therapeutic alliance between oncologists and Latino advanced cancer patients. This intervention will be grounded in the theoretical model of the TA and a conceptual model of the TA in Latino cancer patients that we will develop through the proposed formative research. Based on data from the literature and our preliminary studies, this intervention will seek to improve oncologist TA by promoting trust, empathy, shared decision-making, and patient-centered communication. The intervention framework will be based on Self Determination Theory (SDT), which posits that behaviour change (improvement in TA) is more likely when conditions of autonomy, competence, and relatedness are met. First, mixed methods will be used to create a conceptual model of the TA between oncologists and Latino cancer patients to determine targets for the intervention (Fig 1). Aim1a will leverage data from an ongoing funded multi-site, prospective observational R01 on medical/religious/cultural beliefs, TA, and EOL care outcomes (n>270). For Aim 1b, we will conduct in-depth interviews and focus groups with oncologists (n=9) and Latino cancer patients (n=35) in order to gain a more nuanced understanding of the TA and refine our conceptual model. Once the intervention has been created, we will then refine the intervention using stakeholder (Aim 1b participants) feedback regarding its feasibility and acceptability. For Aim 3, an independent set of 8 oncologists and 50 patients will be studied, half (n=4 oncologists, 25 patients) will be randomized to training in the TA intervention, and the other half (n=4, 25) will be randomized in to usual care. We will examine feasibility (rate of intervention completion), acceptability (oncologists’ and patients’ satisfaction), and efficacy of the TA intervention for improving the TA between oncologists and Latino cancer patients, as measured by patient THC scores as the primary outcome. Secondary outcomes will include engagement in ACP and EOL care. Dr. Tergas’s long-term career goal is to establish a leading, independent program of research focused on the reduction of disparities in EOL care by implementing and disseminating effective, empirically-supported interventions for use in clinical practice. As a foundation for her independent research program, her short-term career goal is to develop an implementable, evidence-based behavioral intervention for improving therapeutic alliance between oncologists and Latino cancer patients. This K08 award application represents the cornerstone of her strategy to achieve my short- term goal and consists of cohesive and complementary research aims and training objectives. Specifically, in order to achieve her career goals, she needs training in intervention development and implementation science, as well as continued training and mentorship in EOL care disparities. Conducting the research detailed in my research aims will help me achieve this training and experience, as well as provide preliminary data for a future R01-level grant application.

项目概要 该提案旨在开发并试点测试一种有理论依据的行为干预措施，以促进 肿瘤学家和拉丁裔晚期癌症患者之间建立治疗联盟。这 干预将基于 TA 的理论模型和拉丁裔 TA 的概念模型 我们将通过拟议的形成性研究来培养癌症患者。根据来自的数据 文献和我们的初步研究，这种干预措施将寻求通过促进信任来改善肿瘤学家 TA， 同理心、共同决策和以患者为中心的沟通。干预框架将是 基于自我决定理论 (SDT)，该理论认为行为改变（TA 的改进）更重要 当自主性、能力和相关性条件得到满足时，很可能会发生这种情况。首先，将使用混合方法 创建肿瘤学家和拉丁裔癌症患者之间 TA 的概念模型以确定目标 进行干预（图 1）。 Aim1a 将利用来自持续资助的多站点、前瞻性项目的数据 关于医疗/宗教/文化信仰、TA 和 EOL 护理结果的观察性 R01 (n>270)。对于目标 1b，我们 将与肿瘤学家 (n=9) 和拉丁裔癌症患者 (n=35) 进行深入访谈和焦点小组讨论 为了更细致地了解 TA 并完善我们的概念模型。一旦干预 创建完成后，我们将利用利益相关者（目标 1b 参与者）的反馈完善干预措施 考虑其可行性和可接受性。对于目标 3，将由 8 名肿瘤学家和 50 名患者组成的独立组 研究中，一半（n = 4 名肿瘤科医生，25 名患者）将被随机分配接受 TA 干预培训，另一半 一半（n=4, 25）将被随机分配到常规护理中。我们将审查可行性（干预完成率）， TA 干预改善 TA 的可接受性（肿瘤科医生和患者的满意度）和有效性 肿瘤学家和拉丁裔癌症患者之间的研究，以患者 THC 评分作为主要结果来衡量。 次要结果将包括参与 ACP 和 EOL 护理。 Tergas 博士的长期职业目标是 建立一个领先的、独立的研究计划，重点关注减少 EOL 护理方面的差异 实施和传播有效的、有经验支持的干预措施，用于临床实践。作为一个 她的独立研究计划的基础，她的短期职业目标是开发一个可实施的、 基于证据的行为干预，以改善肿瘤学家和拉丁裔之间的治疗联盟 癌症患者。这次 K08 奖项申请代表了她实现我的短期战略的基石 术语目标由有凝聚力和互补性的研究目标和培训目标组成。具体来说，在 为了实现她的职业目标，她需要干预开发和实施科学方面的培训， 以及关于 EOL 护理差异的持续培训和指导。进行我的详细研究 研究目标将帮助我获得这种培训和经验，并为未来提供初步数据 R01级资助申请。