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

项目总结 这项建议旨在开发和试点一种有理论基础的行为干预措施，以促进 发展肿瘤学家和拉丁裔晚期癌症患者之间的治疗联盟。这 干预将以助教的理论模型和拉丁裔助教的概念模型为基础 我们将通过拟议的形成性研究来开发癌症患者。基于来自 文献和我们的初步研究，这项干预将寻求通过促进信任来改善肿瘤学家的TA， 同理心、共同决策和以病人为中心的沟通。干预框架将是 基于自我决定理论(SDT)，该理论认为行为变化(TA的改善)更多 很可能在自治、能力和关联性的条件得到满足时。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的TA概念模型以确定目标 用于干预(图1)。Aim1a将利用来自持续资助的多个站点的数据， 关于医疗/宗教/文化信仰、TA和EOL护理结果的观察性R01(n&gt；270)。对于目标1b，我们 将在#年与肿瘤学家(n=9)和拉丁裔癌症患者(n=35)进行深入访谈和焦点小组 以便对助教有更细微的了解，并完善我们的概念模型。一旦干预行动 已创建，然后我们将使用利益相关者(目标1b参与者)反馈来细化干预 关于其可行性和可接受性。对于AIM 3，由8名肿瘤学家和50名患者组成的独立组将是 在研究中，一半(n=4名肿瘤学家，25名患者)将随机接受TA干预培训，而另一半将被随机接受TA干预培训 一半(n=4，25)患者将随机进入常规护理。我们将研究可行性(干预完成率)， 可接受性(肿瘤学家和患者的满意度)和TA干预改善TA的有效性 肿瘤学家和拉丁裔癌症患者之间的关系，以患者THC评分作为主要结果。 次要结果将包括参与ACP和EOL护理。特加斯博士的长期职业目标是 建立领先的独立研究计划，专注于通过以下方式减少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。作为一名 作为她的独立研究计划的基础，她的短期职业目标是开发一种可实施的、 循证行为干预促进肿瘤学家与拉丁裔的治疗联盟 癌症患者。这份K08奖项申请代表了她实现我的短期战略的基石- 学期目标，由相互衔接和互补的研究目标和培训目标组成。具体而言，在 为了实现她的职业目标，她需要接受干预开发和实施科学方面的培训， 以及在EOL护理差距方面的持续培训和指导。进行详细的研究，在我的 研究目标将帮助我实现这一培训和经验，并为未来提供初步数据 R01级拨款申请。

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.