Black-White Differences in Advanced Cancer Communication, Acceptance, and Care

晚期癌症沟通、接受和护理方面的黑白差异

• 批准号: 8211543
• 负责人: Holly Gwen Prigerson
• 金额: $ 4.05万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-04-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8211543
• 关键词: Achievement; Address; Advance Care Planning; Advanced Malignant Neoplasm; Affect; Age; Benefits and Risks; Beryllium; Boston; Cancer Patient; Caregivers; Caring; Clinic Visits; Clinical; Cognitive; Communication; Conscious; Cultural Diversity; Data; Data Set; Decision Making; Disclosure; Do Not Resuscitate Order; Enrollment; Environmental air flow; Family; Family member; Friends; Gender; Genetic Transcription; Goals; Health Communication; Healthcare; Healthcare Systems; Intensive Care; Intervention; Interview; Knowledge; Life; Life Expectancy; Life Extension; Malignant Neoplasms; Mediating; Mediation; Medical; Mentally Ill Persons; Modeling; Not Hispanic or Latino; Nurse Practitioners; Oncologist; Outcome; Palliative Care; Parents; Patient Care; Patient Preferences; Patients; Physicians; Procedures; Process; Provider; Psychosocial Influences; Public Health; Quality of life; Recruitment Activity; Relative (related person); Reporting; Research; Research Infrastructure; Resources; Resuscitation; Role; Sampling; Services; Site; Social support; Spirituality; Stage at Diagnosis; Surveys; Tape Recording; Terminal Disease; Terminally Ill; Testing; Treatment outcome; Visit; Work; base; coping; cost; cultural competence; design; end of life; health literacy; hospice environment; improved; information gathering; meetings; oncology; outcome forecast; preference; prevent; prognostic; public health relevance; quality of death; therapy development

DESCRIPTION (provided by applicant): Results from our "Quality of Death: Ethnic and Psychosocial Influences" ["Coping with Cancer" (CwC)] study demonstrate that at the end-of-life (EOL) black, compared with white, cancer patients receive more intensive, expensive, non-curative care (e.g., higher rates of ICU stays, ventilation, and resuscitation). We find that intensive care does not prolong life, but does impair quality of life. CwC results also reveal that black, compared to white, advanced cancer patients are less likely to consider themselves terminally ill, are more likely to prefer life-prolonging treatments, and are less likely to engage in advance care planning. In the full CwC sample, EOL discussions with physicians are associated with greater patient acceptance of terminal illness, a preference for comfort care over life-extension, fewer life-prolonging procedures, more palliative care, and receipt of care consistent with patient wishes. However, among black CwC patients, EOL discussions are not associated with greater acceptance of terminal illness, EOL care received, or EOL care consistent with patient wishes. This raises the question of how communication between oncology providers and patients may differ by whether the patient is black or white, and how these differences contribute to disparities in EOL care. For this CwC renewal, we apply the Structural Influence Model of Health Communication to determine how EOL communication processes (e.g., oncology provider's prognostic disclosure) vary depending on whether the patient is black or white. It posits that the effects of communication processes on the achievement of communication goals (e.g., acceptance of illness) will be weaker for black compared with white patients. Likewise, it posits that the effects of communication goals on EOL outcomes (i.e., intensive/palliative care received, receipt of care consistent with patient preferences, and quality of life) will be weaker in black compared with white patients. We propose to enroll 400 advanced cancer patients (200 black and 200 white patients) with a less than 6 month life-expectancy. Patients and their primary family/friend caregiver will be recruited from sites in Boston (MA), Dallas (TX), and Richmond (VA). At baseline, enrolled patients will complete a brief pre-clinic visit survey. The clinic visit will be audio-taped and patients, caregivers and the patient's primary oncology provider will be interviewed after the visit. Patients will be interviewed before and after their clinic visit one month later. That clinic visit will also be audio-taped. Medical care received in the last month of life will be documented via chart extraction. The caregiver interviewed at baseline will be interviewed one month post-loss about the health care the patient received in the final month and about the patient's mental and physical status in the last week of life. Results will indicate which communication processes and communication goals are promising targets for interventions to reduce black-white disparities in EOL care and improve quality of life for all cancer patients. PUBLIC HEALTH RELEVANCE: The disproportionately high rates of intensive, non-curative, burdensome care received by black relative to white advanced cancer patients at the end of life (EOL) has been recognized as a serious public health concern. This study will examine how EOL communications between advanced cancer patients, caregivers, and oncology providers contribute to black-white differences in: a) acceptance of terminal illness, b) knowledge of risks/benefits EOL treatment outcomes, and c) advance care planning, and how these "communication goals" affect the rates at which patients receive: a) intensive, life-prolonging care b) palliative care, c) care consistent with patient preferences, and d) the patient's quality of life at the EOL. Results will inform the development of interventions to promote the cultural-competence of EOL communications to enhance informed decision-making, promote patient quality of life, and reduce disparities in EOL care.

描述（由申请人提供）：我们的“死亡质量：种族和社会心理影响”[“应对癌症”(CwC)] 研究结果表明，与白人相比，黑人在临终 (EOL) 时，癌症患者接受更密集、更昂贵的非治疗性护理（例如，更高的 ICU 入住率、通气和复苏率）。我们发现重症监护并不能延长生命，反而会降低生活质量。 CwC 结果还显示，与白人相比，黑人晚期癌症患者认为自己已患绝症的可能性较小，更有可能更喜欢延长生命的治疗，并且不太可能参与预先护理计划。在完整的 CwC 样本中，与医生的 EOL 讨论与患者对末期疾病的更大接受度、对舒适护理而非延长生命的偏好、更少的延长生命手术、更多的姑息治疗以及接受符合患者意愿的护理相关。然而，在黑人 CwC 患者中，EOL 讨论与更多地接受末期疾病、接受 EOL 护理或符合患者意愿的 EOL 护理无关。这就提出了一个问题：肿瘤医生和患者之间的沟通可能会因患者是黑人还是白人而有所不同，以及这些差异如何导致 EOL 护理的差异。对于本次 CwC 更新，我们应用健康沟通的结构影响模型来确定 EOL 沟通流程（例如，肿瘤学提供者的预后披露）如何根据患者是黑人还是白人而变化。它认为，与白人患者相比，黑人患者的沟通过程对实现沟通目标（例如，接受疾病）的影响较弱。同样，它认为，与白人患者相比，黑人患者的沟通目标对 EOL 结局（即接受的重症/姑息治疗、接受符合患者偏好的护理以及生活质量）的影响较弱。我们建议招募 400 名预期寿命不足 6 个月的晚期癌症患者（200 名黑人和 200 名白人患者）。将从波士顿（马萨诸塞州）、达拉斯（德克萨斯州）和里士满（弗吉尼亚州）的地点招募患者及其主要家人/朋友护理人员。在基线时，登记的患者将完成简短的临床前访视调查。诊所就诊将被录音，患者、护理人员和患者的主要肿瘤科医生将在就诊后接受采访。一个月后，患者将在就诊之前和之后接受采访。这次诊所访问也将被录音。生命最后一个月接受的医疗护理将通过图表提取来记录。在基线时接受采访的护理人员将在失去亲人后一个月接受采访，了解患者在最后一个月接受的医疗保健以及患者在生命最后一周的精神和身体状况。结果将表明哪些沟通过程和沟通目标是有希望的干预目标，以减少 EOL 护理中的黑白差异并提高所有癌症患者的生活质量。 公共卫生相关性：与白人晚期癌症患者相比，黑人在生命末期 (EOL) 时接受强化、非治疗性、繁重护理的比例过高，这已被认为是一个严重的公共卫生问题。本研究将探讨晚期癌症患者、护理人员和肿瘤医生之间的 EOL 沟通如何导致黑白差异：a) 对绝症的接受程度，b) 对 EOL 治疗结果的风险/益处的了解，c) 预先护理计划，以及这些“沟通目标”如何影响患者接受以下治疗的比率：a) 强化、延长生命的护理 b) 姑息治疗，c) 符合患者偏好的护理，以及 d) 患者的质量 停产时的生活。结果将为制定干预措施提供信息，以促进 EOL 沟通的文化能力，从而增强知情决策、提高患者的生活质量并减少 EOL 护理中的差异。