Facilitating Decision Making in Advanced Cancer Patients

促进晚期癌症患者的决策

• 批准号: 7263038
• 负责人: NEAL J. MEROPOL
• 金额: $ 20.7万
• 依托单位: FOX CHASE CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-09-30 至 2009-07-06
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7263038
• 关键词: Accounting; Advanced Malignant Neoplasm; Adverse effects; Adverse reactions; Affect; Affective; Anxiety; Attention; Audiotape; Belief; Benefits and Risks; Cancer Patient; Cessation of life; Client satisfaction; Clinical; Clinical Trials; Clinical Trials Design; Clinical Trials[{..}] Cancer Treatment; Cognition; Cognitive; Communication; Communities; Computer information processing; Computers; Condition; Conflict (Psychology); Consult; Consultations; Coupled; Data; Decision Aid; Decision Making; Development; Disease; Disseminated Malignant Neoplasm; Distress; Education; Educational Intervention; Effectiveness of Interventions; Future; Goals; Health; Individual; Intervention; Investigational Therapies; Length; Life; Malignant Neoplasms; Measures; Medical; Methodology; Nature; Numbers; Nurses; Online Systems; Outcome; Outcome Assessment; Patients; Perception; Phase I Clinical Trials; Physicians; Population; Process; Provider; Quality of life; Quality-Adjusted Life Years; Quality-of-Life Assessment; Randomized; Recruitment Activity; Reporting; Research; Research Design; Risk; Schedule; Standards of Weights and Measures; Summary Reports; Supportive care; Surveys; Systemic Therapy; Testing; Time; Toxic effect; Treatment outcome; Uncertainty; United States; Upper arm; Ursidae Family; Work; base; cancer therapy; communication aid; computer generated; design; desire; expectation; experience; follow-up; improved; mortality; outcome forecast; patient expectation; preference; prospective; satisfaction; skills training; social; tool

DESCRIPTION (provided by applicant): The development of improved systemic therapies for cancer generally begins with clinical trials in patients with metastatic disease for whom standard approaches have either failed, have low expectation of benefit, or do not exist. These patients are particularly vulnerable, given their generally poor short-term prognoses and lack of encouraging standard treatment options. This vulnerability, coupled with uncertainty regarding potential benefits and toxicities of experimental therapy, creates a unique and difficult medical decision making context. Our previous work suggests that important goals of medical decision making are not routinely being met for advanced cancer patients considering treatment options, including satisfactory discussion of issues consonant with individual patient values, and effective communication of physician expectations of potential risks and benefits of therapy. The overall goal of this proposal is to develop a communication aid for patients with metastatic cancer to facilitate treatment decision making. An interactive web-based tool that assesses patient values and information needs, provides education about cancer treatment, and provides communication skills training will be developed and tested. A computer-generated report will be provided to the consulting physician before the patient encounter that provides summary information about patient values, wishes regarding shared decision making, and desires regarding the detail and nature of how potential risk and benefit information is presented to them. The aims of this research are to measure the effect of this intervention (using a randomized clinical trial design) on 1) patient satisfaction with the physician consultation, and decisional conflict, 2) patient expectations regarding potential benefits and side effects from treatment options, and 3) content of physician-patient consultation. Patients with advanced cancer who are scheduled for an initial consultation will be recruited for this multi-center study. Patients will participate in a web-based survey and education intervention, post-consultation survey, and 3-month follow up survey. A subsample of physician consultations will be audiotaped and their content analyzed.

描述（由申请人提供）：改进的癌症全身疗法的开发通常始于对患有转移性疾病的患者进行临床试验，对于这些患者来说，标准方法要么失败，要么获益预期较低，要么不存在。鉴于这些患者的短期预后普遍较差且缺乏令人鼓舞的标准治疗方案，他们特别容易受到伤害。这种脆弱性，加上实验治疗的潜在益处和毒性的不确定性，造成了独特且困难的医疗决策背景。 我们之前的工作表明，对于考虑治疗方案的晚期癌症患者来说，通常无法实现医疗决策的重要目标，包括对符合患者个体价值观的问题进行令人满意的讨论，以及有效地传达医生对治疗潜在风险和益处的期望。该提案的总体目标是为转移性癌症患者开发一种沟通辅助工具，以促进治疗决策。将开发和测试一种基于网络的交互式工具，用于评估患者价值观和信息需求、提供有关癌症治疗的教育以及提供沟通技巧培训。在与患者会面之前，将向咨询医生提供一份计算机生成的报告，其中提供有关患者价值观的摘要信息、有关共同决策的愿望以及有关如何向患者呈现潜在风险和益处信息的细节和性质的愿望。本研究的目的是衡量这种干预措施（使用随机临床试验设计）对 1) 患者对医生咨询的满意度和决策冲突的影响，2) 患者对治疗方案的潜在益处和副作用的期望，以及 3) 医患咨询的内容。这项多中心研究将招募计划进行初步咨询的晚期癌症患者。患者将参加基于网络的调查和教育干预、咨询后调查和3个月的随访调查。医生咨询的子样本将被录音并分析其内容。