PATTERNS CARE FOR CANCER PATIENTS AT END OF LIFE

描述：本提案是为第一个奖项（R29）提交的。 近年来，美国人的死亡方式吸引了越来越多的 公众关注。 随着癌症患者越来越多地要求 帮助结束他们的生命，一些人认为，太少关注， 在最后几个月的生活质量。 一些州的选民 发起了关于在重病时结束自己生命的权利的公民投票， 尽管1997年最高法院裁定， 医生协助自杀 尽管如此，那些继续领导公众 要求对死亡过程进行更多的个人控制， 描述无法控制的疼痛或其他无法忍受的癌症患者 症状 相对而言，人们对死亡体验的质量知之甚少， 癌症患者，尤其是从患者的角度来看， 在生命的最后几个月使用的护理模式。 的总目标 本研究旨在描述癌症患者的临终经历， 具体类型的护理，所消耗的资源，以及护理是否 符合患者的偏好。 该项目将使用两个 免费的数据库，以实现这一目标：1。 学习理解 预后和偏好的结果和治疗风险（支持） 数据库，2。 监测、流行病学和最终结果（SEER） 程序数据库 这两个数据库已与医疗保险索赔数据合并 对于65岁以上的患者。 建议的研究将分四个重叠阶段进行， 自己的具体目标。 第一阶段将描述 严重肺癌和结肠癌患者，包括偏好 在乎 第二阶段将描述癌症患者的护理模式， 生命的终结 第三阶段将检查护理的性质和强度 在生命的尽头收到。 第四阶段将描述 在不同的时间和地点进行癌症临终关怀。 这项研究将提供一个深入的描述质量的染色 为选定的癌症患者提供经验，并更好地了解 癌症患者在生命的最后六个月接受护理， 他们的护理性质的强度，以及患者的偏好是否 关怀得到尊重。 从研究中获得的信息可以用于 提高临终病人的护理质量， 确定可能需要的资源的性质和数量， 病人的需要。

DESCRIPTION: This proposal is submitted for a first award (R29). In recent years, the way that people die in the U.S. has attracted growing public concern. As suffering cancer patients increasingly request assistance to end their lives, some argue that too little attention is paid to the quality of life in the final months. Voters in some states have sponsored referenda on the right to end one's own life when gravely ill, although the 1997 Supreme Court ruled against the right to a physician-assisted suicide. Nonetheless, those continuing to lead public calls for more individual control over the dying process have frequently been cancer patients who describe uncontrollable pain or other intolerable symptoms. Relatively little is known about the quality of the dying experience for cancer patients, especially from the patient's perspective, or about patterns of care used during the final months of life. The overall goal of this study is to describe the dying experience of cancer patients, focusing on specific types of care, the resources consumed, and whether that care complies with a patient s preferences. The project will use two complimentary databases to achieve this goal: 1. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) database, and 2. The Surveillance, Epidemiology, and End Results (SEER) program database. Both databases have been merged with Medicare claims data for patients older than 65 years. The proposed study will be conducted in four overlapping phases, each with its own specific aims. Phase one will describe the dying experience of the seriously ill lung and colon cancer patients, including preferences for care. Phase two will describe patterns of care for cancer patients at the end of life. Phase three will examine the nature and intensity of care received at the end of life. Phase four will describe variations in end-of-life cancer care across place and time. This study will provide an in-depth description of the quality of the dying experience for selected cancer patients, and a better understanding of where cancer patients receive care during their last six months of life, the intensity of nature of their care, and whether patients' preferences for care are being respected. Information obtained from the study can be used to improve the quality of care for patients at the end of life and help to determine the nature and amount of resources that might be required to meet patients' needs.