Latino vs. Non-Latino Disparities in Advance Care Planning & End-of-Life Care

描述（由申请人提供）：在这个项目中，我们旨在解释和减少拉丁裔/非拉丁裔在预先护理计划（ACP）和临终关怀（EOL）方面的差异。拉丁美洲晚期癌症患者比非拉丁美洲晚期癌症患者更不可能参与ACP，这是一种帮助绝症患者及其家属实现EOL护理目标的做法。与ACP的差异一致，拉丁裔晚期癌症患者比非拉丁裔患者更常接受积极、繁重的EOL治疗。他们也比其他人更不可能使用临终关怀服务和接受符合他们偏好的EOL护理。因此，拉丁裔晚期癌症患者接受的EOL护理似乎不是最理想的，不如非拉丁裔患者接受的护理，很少受到ACP的指导，而且往往与他们的价值观背道而驰。在这个项目中，我们将通过两个密切相关的子项目来解决ACP和EOL护理中的这些差异。在这些子项目中的第一个项目中，我们的目标是确定导致拉丁裔/非拉丁裔在ACP和EOL护理中的差异的信念（具体目标1）。我们将对400名晚期癌症患者（N=200拉丁裔；N=200非拉丁裔）及其非正式照顾者（如配偶；N=400）进行信念、ACP和EOL结果的观察性研究，这些患者将从纽约市、达拉斯和芝加哥的诊所招募。在这项观察性研究中，我们将研究宗教、家庭和文化医学信仰在多大程度上调解或缓和拉丁裔/非拉丁裔在ACP和EOL护理中的差异，并确定具有重要影响的信仰作为减少这些差异的干预的潜在目标。在第二个子项目中，以本观察性研究的结果为指导，我们的目标是开发和试点一种信仰情境化干预措施，以减少拉丁裔/非拉丁裔在ACP和EOL护理中的差异（具体目标2）。具体目标2将分三个阶段进行。在第一阶段，我们将简要回顾具体目标1的结果，并要求拉丁裔利益相关者就可能的信仰情境化干预措施提供意见，以确定哪些措施可能对拉丁裔社区最有效，并为其所接受。在第二阶段，我们将设计一种信仰情境化干预措施，以减少拉丁裔/非拉丁裔在ACP和EOL护理中的差异，该干预措施将纳入第一阶段确定的要素，然后与一组单独的拉丁裔利益相关者一起审查该干预措施。在第三阶段，我们将评估在第二阶段开发的信念-情境化干预的可行性和潜在功效。总体而言，本研究的结果将确定解释拉丁裔/非拉丁裔在ACP和EOL护理中的差异的有影响力的信念，并提供有效方法来减少拉丁裔/非拉丁裔在ACP和EOL护理中的差异，并最终减少EOL护理。

DESCRIPTION (provided by applicant): In this project, we aim to explain and reduce Latino/non-Latino disparities in advance care planning (ACP) and end-of-life (EOL) care. Latino advanced cancer patients are less likely than non-Latino advanced cancer patients to engage in ACP - a practice to help terminally ill patients and their families achieve EOL goals of care. Consistent with this disparity in ACP, Latino advanced cancer patients receive aggressive, burdensome EOL care more often than do their non-Latino counterparts. They are also less likely than others to use hospice services and to receive EOL care in line with their preferences. Consequently, the EOL care that Latino advanced cancer patients receive appears to be suboptimal, inferior to the care that non-Latino patients receive, infrequently guided by ACP, and often counter to their values. In this project, we will address these disparities in ACP & EOL care through two closely related sub-projects. In the first of these sub-projects, we aim to identify beliefs that contribute to Latino/non-Latino disparities in ACP & EOL care (Specific Aim 1). We will conduct an observational study of beliefs, ACP and EOL outcomes in 400 advanced cancer patients (N=200 Latino; N=200 non-Latino) and their informal caregivers (e.g., spouses; N=400) whom we will recruit from clinics in New York City, Dallas, and Chicago. In this observational study, we will examine the extent to which religious, familial and cultural medical beliefs mediate or moderate Latino/non-Latino disparities in ACP & EOL care, and identify significantly influential beliefs as potential targets of an intervention to reduce those disparitis. In the second sub-project, using results from this observational study as a guide, we aim to develop and pilot a belief-contextualization intervention to reduce Latino/non-Latino disparities in ACP & EOL care (Specific Aim 2). Specific Aim 2 will proceed in three phases. In Phase I, we will briefly review results of Specific Aim 1 and ask Latino stakeholders to provide input on possible belief-contextualization interventions to determine those likely to be most effective in, and acceptable to, Latino communities. In Phase II, we will design a belief-contextualization intervention to reduce Latino/non-Latino disparities in ACP & EOL care that incorporates elements identified in Phase I and then vet that intervention with a separate group of Latino stakeholders. In Phase III, we will evaluate the feasibility and potential efficacy of the belief-contextualization intervention developed in Phase II. Overall, results of this study will identify influential beliefs that explain Latino/non-Latino disparities in ACP & EOL care, and offer the promise of an effective approach to the reduction of Latino/non-Latino disparities in ACP, and, ultimately, EOL care.