Impact of Specialist Palliative Care on Outcomes in Advanced Stage Lung Cancer

 描述（由申请人提供）：本提案将确定专家姑息治疗对以患者为中心的结局的影响以及晚期肺癌患者的癌症护理质量。此外，将探讨在临床实践中整合的障碍和促进因素。专科姑息治疗减轻患者的症状负担，提高生活质量，但在临床实践中没有得到充分利用。国家癌症政策委员会 将低质量的癌症护理定义为“已知有效的实践未得到充分利用”。当前姑息治疗研究中的重要知识缺口导致了这种利用不足。中心假设是，早期，综合专科姑息治疗改善了晚期肺癌患者的癌症护理的结果和质量。在混合方法的方法，姑息治疗转诊和医疗保健利用和患者死亡率之间的关联将被确定。将首次确定姑息治疗过程的变化及其与护理质量变化的关联。 提供者对与常规肺癌护理整合的障碍和促进因素的看法将 被探索。所有这些研究都将在国家退伍军人事务部医疗保健系统中进行，利用强大的癌症登记和全面的患者护理数据库。该提案的结果将为制定有效的姑息治疗模式提供信息，以便在医疗保健系统中实施。该模型预计将适用于综合医疗保健系统，并可能最终在其他晚期癌症患者群体中进行测试。所提出的研究的基本原理是，它有可能减少因素 这减少了姑息治疗的使用，并对肺癌治疗模式产生了重大影响。该提案具有确定干预措施的巨大潜力，这些干预措施可以改善护理提供，增强临终体验，并促进姑息治疗的更多利用 在临床实践中。这项建议与国家癌症研究所的使命有关，即支持与癌症治疗有关的研究以及对病人及其家属的持续护理。这项研究是主要研究者K07职业发展计划的一个组成部分，该计划表明了朝着研究独立性的逻辑科学进展，最终目标是在奖励期结束前获得R级资金。科学技能发展的详细计划，并获得作为一个混合方法研究人员的熟练程度包括在这个建议。俄勒冈州健康与科学大学和波特兰退伍军人事务医疗中心的支持性研究环境为这一提议的可行性提供了证据。研究进展和职业发展将由一组精选的高级研究人员监督，并由卫生服务研究与发展中心和俄勒冈州临床和转化研究所学者计划为早期职业研究人员提供支持。

 DESCRIPTION (provided by applicant): This proposal will determine the impact of specialist palliative care on patient-centered outcomes and the quality of cancer care among advanced stage lung cancer patients. In addition, barriers and facilitators to integration in clinical practce will be explored. Specialist palliative care decreases patients' symptom burden and improves quality of life, but it is underutilized in clinical practice. The National Cancer Policy Board has defined poor-quality cancer care as when "practices of known effectiveness are being underutilized". Important knowledge gaps in current palliative care research contribute to this underutilization. The central hypothesis is that early, integrated specialist palliative care improves outcomes and the quality of cancer care among advanced stage lung cancer patients. In a mixed-methods approach, the association between palliative care referral and healthcare utilization and patient mortality will be determined. For the first time, variations in the processs of palliative care and their association with variations in the quality of care will be determined. Providers' perceptions of barriers and facilitators to integration with usual lung cancer care will be explored. All of these studies will be conducted in the national Veterans Affairs healthcare system utilizing a robust cancer registry and comprehensive patient care databases. The results from this proposal will inform the development of an effective palliative care model for implementation in healthcare systems. This model is expected to be applicable to integrated healthcare systems and may eventually be tested in other advanced cancer patient populations. The rationale that underlies the proposed research is that it has the potential to diminish factors that have decreased uptake of palliative care and substantially impact the lung cancer treatment paradigm. This proposal has significant potential to identify interventions that could improve care delivery, enhance end- of-life experiences, and promote greater utilization of palliative care in clinical practice. This proposal is relevant to the mission of the National Cancer Institute to support research concerned with the treatment of cancer and the continuing care of patients and their families. This research is one component of the principal investigator's K07 career development plan that demonstrates a logical scientific progression towards research independence with the ultimate goal of obtaining R-level funding by the end of the award period. A detailed plan for scientific skill development and obtaining proficiency as a mixed-methods researcher are included in this proposal. Lending evidence to the feasibility of this proposal is the supportive research environments at Oregon Health and Science University and the Portland Veterans Affairs Medical Center. Research progress and career development will be overseen by a select group of senior investigators, and supported by the Health Services Research & Development center and the Oregon Clinical and Translational Research Institute Scholar's Program for early career investigators.