Communicating the Gist of Prognosis: An intervention to improve prognostic understanding in advanced lymphoma

传达预后要点：提高对晚期淋巴瘤预后了解的干预措施

• 批准号: 10526566
• 负责人: Kelly McConnell
• 金额: $ 27.44万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-25 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10526566
• 关键词: Address; Advance Care Planning; Advance Directives; Advanced Malignant Neoplasm; Agreement; Black race; Cancer Center; Cancer Patient; Caring; Cessation of life; Clinical Research; Communication; Decision Making; Development; Diagnosis; Disease; Disease Progression; Do Not Resuscitate Order; Enrollment; Focus Groups; Foundations; Goals; Health Personnel; Healthcare; Hearing; Hematologic Neoplasms; Hematologist; Hematology; Hospice Care; Intensive Care; Intervention; Learning; Liquid substance; Lymphoma; Malignant Neoplasms; Medical; National Institute on Minority Health and Health Disparities; Oncologist; Outcome; Palliative Care; Participant; Patients; Pre-Post Tests; Prognosis; Public Health; Quality of life; Race; Randomized Controlled Trials; Refractory Disease; Relapse; Research; Risk; Solid; Solid Neoplasm; Surgeon; Survival Rate; Techniques; Testing; Training; Treatment Efficacy; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; acceptability and feasibility; base; black patient; black/white disparity; care preference; clinical care; college; end of life; end of life care; health goals; health literacy; hospice environment; hospital admission rate; improved; information processing; innovation; intervention effect; novel strategies; patient engagement; pilot test; post intervention; preference; primary outcome; prognostic; racial disparity; racial health disparity; satisfaction; secondary outcome; standard care; theories; therapy design; tumor

PROJECT SUMMARY Prognostic understanding is vital to advanced cancer patients’ ability to receive end-of-life (EOL) care consistent with their preferences. Advanced cancer patients who have an accurate prognostic understanding are more likely to engage in advance care planning (ACP; e.g. do-not-resuscitate order), prefer comfort care over intensive care, receive care consistent with their preferences, and die in their preferred place of death. Research on prognostic understanding has largely focused on white patients with advanced solid tumors. This gap is notable due to the unique disease trajectory of advanced lymphoma. While the initial treatment goal is cure, prognosis suddenly and dramatically worsens following disease progression with the majority of patients nearing death. Less than half of patients with a hematologic malignancy have an accurate understanding of their prognosis or engage in ACP and hematologic malignancy patients are more likely to receive intensive EOL care than solid tumor patients. Further, black patients have higher rates of poor prognostic understanding and burdensome intensive EOL care and are less likely to engage in ACP than white patients. The low rates of ACP and high rates of intensive EOL care in patients with hematologic malignancies, especially black patients, point to a need for interventions to improve prognostic understanding and reduce racial disparities in ACP. The purpose of this project is to refine and pilot test a communication intervention to improve black and white advanced lymphoma patient prognostic understanding and engagement in ACP. The goals of this study are to: (1) develop a culturally appropriate communication intervention to improve hematologists’ ability to clearly communicate to black and white patients about prognosis; (2) evaluate the feasibility and acceptability of the intervention among hematologists and black and white advanced lymphoma patients; and (3) test the pre-post effect of the intervention on black and white patient prognostic understanding (primary outcome), engagement in ACP, completion of advance directives, quality of life, patient and hematologist communication satisfaction, and patient-hematologist agreement on the patient’s healthcare values (secondary outcomes). To meet these goals, we will conduct focus groups with hematologists (n=16) and black and white advanced lymphoma patients (n=32) to improve the intervention. Next, we will pilot test the intervention with n=8 hematologists and n=40 patients and assess outcomes at baseline, post-intervention, and three months later to examine the feasibility, acceptability, and pre-post effect of the intervention. These results will inform a NIH R01 application to conduct a large-scale randomized controlled trial of intervention efficacy. Grounded in the established Fuzzy Trace Theory, the present study takes the novel approach of targeting information processing strategies used during decision making. This project will form a strong foundation for research on this brief scalable intervention with strong potential to improve prognostic understanding, ACP, and values-concordant EOL care.

项目概要 了解预后对于晚期癌症患者接受临终 (EOL) 护理的能力至关重要 符合他们的喜好。对预后有准确了解的晚期癌症患者 更有可能参与预先护理计划（ACP；例如不复苏令），更喜欢舒适护理 超过重症监护，接受符合他们喜好的护理，并在他们喜欢的死亡地点死亡。 对预后了解的研究主要集中在患有晚期实体瘤的白人患者。这 由于晚期淋巴瘤独特的疾病轨迹，差距非常显着。虽然最初的治疗目标是 治愈后，大多数患者的预后在疾病进展后突然急剧恶化 濒临死亡。不到一半的血液恶性肿瘤患者能够准确理解 他们的预后或患有 ACP 和血液恶性肿瘤的患者更有可能接受强化治疗 EOL 护理优于实体瘤患者。此外，黑人患者对预后了解较差的比例更高 和繁重的重症监护，并且比白人患者更不可能进行 ACP。低利率 血液系统恶性肿瘤患者（尤其是黑人患者）的 ACP 和重症 EOL 护理率较高， 指出需要采取干预措施来提高对 ACP 的预后理解并减少种族差异。这 该项目的目的是完善和试点测试通信干预措施，以改善黑白 晚期淋巴瘤患者预后的理解和参与 ACP。本研究的目标是： (1) 制定文化上适当的沟通干预措施，以提高血液学家清楚了解的能力 与黑人和白人患者沟通预后； (2)评估方案的可行性和可接受性 对血液科医生和黑人和白人晚期淋巴瘤患者进行干预； (3) 测试前置 干预对黑人和白人患者预后理解（主要结果）、参与度的影响 在 ACP 中，完成预先指示、生活质量、患者和血液科医生的沟通满意度、 患者与血液科医生就患者的医疗保健价值观达成一致（次要结果）。为了满足这些 目标，我们将与血液科医生 (n=16) 和黑白晚期淋巴瘤进行焦点小组讨论 患者（n=32）改善干预措施。接下来，我们将与 n=8 名血液学家一起试点测试干预措施 n=40 名患者，评估基线、干预后和三个月后的结果，以检查 干预的可行性、可接受性和前后效果。这些结果将为 NIH R01 申请提供信息 开展大规模随机对照干预效果试验。以既定的模糊为基础 痕迹理论，本研究采用了针对所使用的信息处理策略的新颖方法 在决策过程中。该项目将为这一简短的可扩展研究奠定坚实的基础 具有很大潜力的干预措施，可以改善预后理解、ACP 和价值观一致的 EOL 护理。