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，我们的目标是解释和减少拉丁美洲/非拉丁美洲的差异，在提前护理计划（ACP）和临终关怀（EOL）。拉丁裔晚期癌症患者比非拉丁裔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人实现EOL护理目标的做法。与ACP的这种差异相一致，拉丁裔晚期癌症患者比非拉丁裔患者更经常接受积极的，繁重的EOL护理。他们也不太可能比其他人使用临终关怀服务，并根据自己的喜好接受临终关怀。因此，拉丁裔晚期癌症患者接受的终末期护理似乎是次优的，不如非拉丁裔患者接受的护理，很少由ACP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。在这些子项目的第一个，我们的目标是确定的信念，有助于拉丁美洲/非拉丁美洲的差距在ACP & EOL护理（具体目标1）。我们将在400名晚期癌症患者（N=200名拉丁裔; N=200名非拉丁裔）及其非正式护理人员（例如，配偶; N=400），我们将从纽约市、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介导或调节ACP和EOL护理中的拉丁美洲人/非拉丁美洲人差异，并确定具有显著影响力的信仰作为干预的潜在目标，以减少这些神经炎。在第二个子项目中，使用本观察性研究的结果作为指导，我们的目标是开发和试点的信念情境化干预，以减少拉丁美洲/非拉丁美洲的差距在ACP和EOL护理（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提供可能的信仰背景化干预措施的投入，以确定那些可能是最有效的，并接受，拉丁裔社区。在第二阶段，我们将设计一个信念情境化干预，以减少拉丁美洲人/非拉丁美洲人在ACP和EOL护理中的差异，其中包括第一阶段确定的要素，然后与一组单独的拉丁美洲利益相关者一起审查该干预。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疗效。总体而言，本研究的结果将确定解释ACP和EOL护理中拉丁裔/非拉丁裔差异的有影响力的信念，并提供一种有效的方法来减少ACP中拉丁裔/非拉丁裔差异，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.