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会导致预后不佳。 治疗决策和临终关怀计划，对患者产生深远的负面影响， 家庭和社会后果。解决这一问题的现有干预措施侧重于提供 患者更多地了解自己的预后，但影响在很大程度上是有限的，表明即使是 当给予信息时，患者往往不现实，对预后的理解也不准确。 因此，迫切需要研究和干预，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一种跨学科的 心理科学、癌症治疗决策和生命周期研究的交叉学科 结果，这满足了这一需求。因此，这里提出了一个在他的背景中架起桥梁的培训计划 作为一名临床心理学家参与EOL研究。候选人在研究考试方面有很强的背景 人们将主要的、令人厌恶的生活经历(如创伤)融入新生活的心理过程 目标和期望。在K99/R00项目中，他将把这些成熟的文献应用到如何先进 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 了解、决策和停产结果。他将接受专家的跨学科指导 从事EOL研究、决策、医学肿瘤学、精神病学和测量科学。带着他们的 指导，他将确定和衡量患者使用的不同类型的努力来调和的可能性 带着目标和期望死去(目标1；K99阶段)。在目标2(R00阶段)，候选人将纵向 检查不同的努力，以确定哪些可以更好地预测后续EOL结果，包括 患者理解、抗癌治疗的知情使用、护理计划、心理健康、收据 在生命最后一周的价值一致性护理，以及死后对照顾者和家人的影响。目标1和目标2 将因此成为在未来研究中使用的有价值的工具，并确定管理目标和 对于未来的结果，预期是最理想的。然后可以开发出帮助患者的干预措施 尽最大努力最大限度地减少他们的痛苦，并使他们能够做出更优化的决策 计划。与研究目标交织在一起的是一套强有力的培训活动，为候选人提供 在治疗决策、EOL结果和心理学方面的跨学科专业知识，以及 测量发展和先进的纵向数据分析。这种专业知识和技能将使 利用心理学原理制定有影响力的创新研究计划的候选人 晚期癌症患者的决策和生命周期结局。

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.