Culturally Competent Communication Intervention to Improve Latinos' Engagement in Advance Care Planning

项目摘要 与白人相比，拉美裔人不太可能参与各种形式的预先护理计划（ACP）， 包括完成预先指令和进行寿命终止（EOL）讨论。机场核心计划对提供 高质量的EOL护理，因为它与患者的EOL愿望得到遵循的可能性更大有关。 拉丁裔晚期癌症患者也明显比他们的白色同行更容易接受徒劳的 在生命的最后阶段，在重症监护室里死去， 他们的偏好和价值观。沈博士的试点工作，沿着目前的文献，表明， ACP可能有助于改善拉丁美洲人的EOL护理。因此，拟议的项目将开发和试点测试一个文化 有效沟通（CCC）。首先，将根据成果制定核心竞争力的干预措施 从嵌入到当前R 01（MPIs：Prigerson，Maciebenski）评估拉丁美洲人的文化， 家庭和宗教信仰，以及他们的知识，动机（准备），并采取行动，从事ACP （n=200）。接下来，开发的CCC干预措施将在拉丁美洲利益相关者中进行审查并进行实地测试 在拉丁裔晚期癌症患者中，使用迭代方法（n=40）指导最终确定 干预最后，一项初步随机试验将检查以下方法的可行性、可接受性和潜在疗效： 核心合作委员会的干预措施，以改善对非加太国家的参与。受试者（n=50）将被随机分配至 干预组（n=25）和注意控制组（n=25）。结果将提供及时的洞察力， 有效、低负担的干预措施，旨在改善拉丁美洲人对非加太的参与。沈医生是理想 考虑到她在社会心理学方面的学术背景， 传播研究沈博士的长期职业目标是领导一个社会科学研究项目 开发旨在改善临终关怀沟通和护理的社会心理干预措施， 在针对种族/族裔少数群体的干预措施方面的专门知识。为了实现这一目标，作为K 07的一部分，沈博士 将接受五个关键领域的强化培训：（1）终末期护理研究;（2）临床干预开发;（3） 基于技术的健康干预;（4）健康差距;（5）专业发展。K 07将 为沈博士提供多种途径，以实现她的培训和研究目标，并提高她的专业知识。 博士沈将与导师和专家顾问进行持续的会议，并参加正式的课程， 教学法、讲习班、会议、互动培训和指导研究经验。建议的K 07 将为一个专注于发展社会心理干预的研究项目奠定基础 改善EOL沟通和护理。在K 07资助期结束时，沈博士将提交R 01 应用，根据本研究的结果。总的来说，K 07将为沈博士提供研究 经验，密集的培训和导师需要成为一个成功的独立研究员。

PROJECT SUMMARY Compared to whites, Latinos are much less likely to engage in various forms of advance care planning (ACP), including completing advance directives and having end-of-life (EOL) discussions. ACP is critical to provision of quality EOL care, as it has been associated with greater likelihood of patients' EOL wishes being followed. Latino advanced cancer patients are also significantly more likely than their white counterparts to receive futile and burdensome aggressive care at the end-of-life, to die in the ICU, and to have care that runs counter to their preferences and values. Dr. Shen's pilot work, along with the current literature, suggests that targeting ACP may help improve Latinos' EOL care. As such, the proposed project will develop and pilot-test a culturally competent communication (CCC) intervention. First, the CCC intervention will be developed based on results from a questionnaire embedded into a current R01 (MPIs: Prigerson, Maciejewski) assessing Latinos' cultural, familial, and religious beliefs as well as their knowledge, motivation (readiness), and action to engage in ACP (n=200). Next, the developed CCC intervention will be vetted among Latino stakeholders and field-tested among Latino advanced cancer patients, using an iterative approach (n=40) to guide the finalization of the intervention. Finally, a pilot randomized trial will examine the feasibility, acceptability, and potential efficacy of the CCC intervention at improving engagement in ACP. Participants (n=50) will be randomly assigned to the intervention (n=25) or attention control group (n=25). Results will provide timely insight into a potentially effective, low burden intervention designed to improve Latinos' engagement in ACP. Dr. Shen is the ideal candidate to spearhead this line of research given her academic background in social psychology and communication research. Dr. Shen's long-term career goal is to lead a program of social scientific research that develops social psychological interventions designed to improve EOL communication and care, with expertise in interventions targeting racial/ethnic minorities. To achieve this goal, as part of her K07, Dr. Shen will receive intensive training in five key areas: (1) EOL care research; (2) clinical intervention development; (3) technology-based health interventions; (4) health disparities, and (5) professional development. The K07 will provide Dr. Shen with several avenues to achieve her training and research goals and enhance her expertise. Dr. Shen will have ongoing meetings with mentors and expert advisors and participate in formal coursework, didactics, workshops, conferences, interactive trainings, and guided research experience. The proposed K07 will form the foundation for a program of research that focuses on developing social psychological interventions to improve EOL communication and care. At the end of the K07 funding period, Dr. Shen will submit an R01 application, based on the results of the present study. Overall, the K07 will provide Dr. Shen with the research experience, intensive training, and mentorship needed to become a successful independent researcher.