Psychological Responses to the Possibility of Dying: Decision-Making Implications for Advanced Cancer Patients

项目摘要 在晚期癌症患者中，对预后的不准确理解导致了不良的预后。 治疗决策和临终（EOL）护理计划，对患者产生深远的负面影响， 家庭和社会的结果。解决这一问题的现有干预措施侧重于提供 患者更多关于其预后的信息，但在很大程度上影响有限，表明即使 当患者得到信息时，他们对预后的理解往往是不切实际和不准确的。 因此，迫切需要研究和干预措施，以解决心理障碍， 更好的患者理解和结果。候选人的职业目标是发展跨学科的 在心理科学，癌症治疗决策和EOL的交叉研究计划 结果，满足了这一需求。因此，这里提出了一个培训计划，桥梁他的背景 作为临床心理学家来做临终关怀研究候选人在研究方面有很强的背景， 人们整合主要的、令人厌恶的生活经历的心理过程（例如，创伤）进入新的生活 目标和期望。在K99/R 00项目中，他将应用这一成熟的文献来说明如何先进地 癌症患者将死亡的可能性与他们的目标和期望相协调，以及这如何塑造他们的生活。 理解、决策和EOL结果。他将接受专家的跨学科指导 在EOL研究，决策，医学肿瘤学，精神病学和测量科学。与他们的 指导，他将确定和衡量不同类型的努力，病人用来调和的可能性， 带着目标和期望死去（目标1; K99阶段）。在目标2（R 00阶段），候选人将纵向 检查不同的努力，以确定哪些预测更好的后续EOL结果，包括准确的 患者理解，知情使用抗癌治疗，护理计划，心理健康，接收 在生命的最后一周，价值观一致的护理，以及死后对照顾者和家庭的影响。目标1和2 因此，将导致一个有价值的工具，用于未来的研究，并确定管理目标和 对未来结果的期望是最优的。然后可以开发干预措施来帮助患者 使用那些最能减少他们痛苦的努力，让他们做出更优化的决定， 布局与研究目标交织在一起的是一套强大的培训活动， 治疗决策，EOL结局和心理学方面的跨学科专业知识，以及 测量开发和先进的纵向数据分析。这些专业知识和技能将使 候选人制定一个有影响力的，创新的研究计划，利用心理学原理，以提高 晚期癌症的决策和终末期结局。

Project Summary Among terminally ill advanced cancer patients, an inaccurate understanding of prognosis leads to poor treatment decision-making and end-of-life (EOL) care planning, with far reaching negative effects on patient, familial, and societal outcomes. Existing interventions to address this problem have focused on providing patients more information about their prognosis, but have been largely limited in impact, showing that even when given information, patients tend to be unrealistic and inaccurate in their prognostic understanding. Therefore, there is an urgent need for research and interventions that account for the psychological barriers to better patient understanding and outcomes. The candidate’s career goal is to develop an interdisciplinary program of research at the intersection of psychological science, cancer treatment decision-making, and EOL outcomes, that addresses this need. Accordingly, proposed here is a training plan that bridges his background as a clinical psychologist to EOL research. The candidate has a strong background in research examining the psychological processes by which people integrate major, aversive, life experiences (e.g., trauma) into new life goals and expectations. In the K99/R00 projects, he will apply this well-established literature to how advanced cancer patients reconcile the possibility of dying with their goals and expectations, and how this shapes their understanding, decision-making, and EOL outcomes. He will receive interdisciplinary mentorship from experts in EOL research, decision-making, medical oncology, psychiatry, and measurement science. With their mentorship, he will identify and measure the different types of efforts patients use to reconcile the possibility of dying with goals and expectations (Aim 1; K99 phase). In Aim 2 (R00 phase), the candidate will longitudinally examine the different efforts, to identify which predict better subsequent EOL outcomes, including accurate patient understanding, informed use of anti-cancer treatments, care planning, psychological well-being, receipt of value-consistent care in the final week of life, and post-death impact on caregiver and family. Aims 1 and 2 will thus lead to a valuable tool for use in future research and identify which ways of managing goals and expectations is most optimal for future outcomes. Interventions could then be developed helping patients employ those efforts that best minimize their distress and allow them to make more optimal decisions and plans. Intermingled with the research aims, is a robust set of training activities giving the candidate interdisciplinary expertise in treatment decision-making, EOL outcomes, and psychology, and skills in measurement development and advanced longitudinal data analysis. Such expertise and skills will allow the candidate to develop an impactful, innovate research program leveraging psychological principles to improve decision-making and EOL outcomes in advanced cancer.