Reducing Disparities in End of Life Cancer Care

减少临终癌症护理方面的差异

• 批准号: 9919329
• 负责人: Manali I Patel
• 金额: $ 16.73万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-18 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9919329
• 关键词: Accident and Emergency department; Address; Adult; Advanced Malignant Neoplasm; Affect; Area; Award; Cancer Death Rates; Cancer Intervention; Caregivers; Caring; Chicago; Cities; Client satisfaction; Coke; Communication; Communication Barriers; Communities; Custom; Development; Diagnosis; Disease; Documentation; Evidence based intervention; Family; Food Services; Funding; Future; Goals; Growth; Health; Health Benefit; Health Personnel; Health Services; Health system; Healthcare; Healthcare Systems; Home visitation; Hospitals; Hour; Industry; Internet; Intervention; Knowledge; Labor Unions; Lead; Location; Logistics; Long-Term Care; Low income; Malignant Neoplasms; Mentors; Methodology; Methods; Minority; Modeling; Multicenter Trials; Nonprofit Organizations; Oncologist; Oncology; Outcome; Patients; Policies; Population; Population Heterogeneity; Process; Provider; Qualitative Methods; Quality of life; Randomized; Reporting; Research; Research Personnel; Sampling; Services; Structure; Symptoms; Telephone; Testing; Training; Treatment Efficacy; United States Department of Veterans Affairs; Universities; Variant; Veterans; Visit; Vulnerable Populations; Wages; Work; acute care; base; cancer care; cancer health disparity; care delivery; care preference; career; community based participatory research; community setting; cost; design; disparity reduction; economic evaluation; end of life; end of life care; ethnic diversity; evidence base; experience; health care disparity; health care service utilization; health organization; hospice environment; improved; inner city; innovation; novel strategies; patient oriented; preference; process repeatability; racial diversity; satisfaction; symptom management

Project Summary/Abstract Low-income and minority populations with cancer experience greater rates of untreated symptoms, emergency department (ED), and hospital use at the end-of-life (EOL) compared with non-minority patients. Communication of patients' EOL care preferences with their healthcare providers can improve care, however, communication barriers between low-income and minority patients and their healthcare providers limit engagement in these discussions. In one Veterans Affairs (VA) facility, we hired and trained lay health workers (LHWs) to assist patients in communicating their EOL preferences to their providers. The intervention lowered ED and hospital use and increased hospice use as compared to Veterans who received usual cancer care. The feasibility and efficacy of this approach in non-VA, community settings remain untested. The objective of this study is to expand the LHW intervention to underserved community settings. The hypothesis is that this approach is feasible and acceptable in the community and can improve patients' quality of life and reduce unwanted EOL healthcare utilization. The candidate and research team will partner with Unite Here Health (UHH), a labor union health organization that provides health benefits for low-income and minority hourly-wage workers. In Aims 1 and 2, the candidate and team will use a unique combination of community-based participatory research (CBPR) and expert panel methods to synthesize perspectives of UHH patients, caregivers, oncology providers and an expert panel to refine the LHW intervention. In Aim 3, the candidate will pilot the refined intervention among 120 patients diagnosed with advanced stages of cancer to determine feasibility and efficacy of the intervention as compared to usual cancer care alone. Results will inform a future, planned multi-center trial. Successful completion of this award has tremendous potential to improve EOL cancer care for vulnerable populations and inform similar approaches nationally. The candidate, Dr. Manali Patel, is a Stanford University oncologist and health services researcher. Her short-term career goals are to gain expertise in community-based participatory research (CBPR) and expert panel methods to refine evidence-based cancer interventions to eliminate disparities for minority and low-income patients in communities. This award will support Dr. Patel's training in the following that draw on mentors' expertise in: 1) CBPR and expert panel methodology (Mentor: Jay Bhattacharya, Co-Mentor: Tumaini Coker) and 2) economic evaluation of healthcare system innovations (Mentor: Jay Bhattacharya). This award will lay the groundwork for an R01 that Dr. Patel will prepare as the next step towards an independent research career. These activities will facilitate the candidate's growth as an independently funded researcher whose long-term goal is to pursue and conduct research in the area of health systems redesign that results in improved health outcomes for low- income and minority patients with cancer. !

项目总结/摘要 低收入和少数族裔癌症患者出现未经治疗的症状、急诊和其他疾病的比例更高。 部门（艾德），并在医院使用寿命结束（EOL）与非少数民族患者相比。 然而，将患者的EOL护理偏好与其医疗保健提供者进行沟通可以改善护理， 低收入和少数民族患者与其医疗保健提供者之间的沟通障碍限制了 参与这些讨论。在一个退伍军人事务部（VA）的设施，我们雇用和培训非专业卫生工作者 （LHWs），以帮助患者将其EOL偏好传达给其提供者。干预降低了 与接受常规癌症护理的退伍军人相比，艾德和医院的使用以及临终关怀的使用增加。 这种方法在非VA社区环境中的可行性和有效性尚未得到验证。的目标 本研究旨在将LHW干预扩展到服务不足的社区环境。假设是， 该方法在社区中是可行和可接受的，可以改善患者的生活质量， 不必要的EOL医疗保健利用。候选人和研究团队将与Unite Here Health合作 (UHH)，一个工会健康组织，为低收入和少数民族小时工资提供健康福利 工人在目标1和2中，候选人和团队将使用基于社区的 参与性研究（CBPR）和专家小组方法，以综合UHH患者的观点， 护理人员、肿瘤学提供者和专家小组来完善LHW干预。在目标3中，候选人将 在120名确诊为晚期癌症的患者中进行精细干预试点， 与单独的常规癌症护理相比，干预的可行性和有效性。结果将告知未来， 计划进行的多中心试验。成功完成该奖项具有巨大的潜力，以改善EOL 为弱势群体提供癌症护理，并在全国范围内宣传类似的做法。候选人马纳利博士 帕特尔是斯坦福大学的肿瘤学家和卫生服务研究员。她的短期职业目标是 获得以社区为基础的参与式研究（CBPR）和专家小组方法的专业知识， 以证据为基础的癌症干预措施，以消除少数民族和低收入患者在 社区.该奖项将支持帕特尔博士在以下方面的培训，这些培训将借鉴导师在以下方面的专业知识： CBPR和专家小组方法（导师：Jay Bhattacharya，联合导师：Tumaini Coker）和2）经济 医疗保健系统创新评估（导师：Jay Bhattacharya）。该奖项将奠定基础， 帕特尔博士将准备的R 01作为迈向独立研究生涯的下一步。这些活动 将促进候选人的成长为一个独立资助的研究人员，其长期目标是追求 并在卫生系统重新设计领域进行研究，以改善低收入者的健康状况， 低收入和少数族裔癌症患者。 !

项目成果

Healthcare delivery interventions to reduce cancer disparities worldwide.

• DOI: 10.5306/wjco.v11.i9.705
• 发表时间: 2020-09-24
• 期刊: World journal of clinical oncology
• 影响因子: 2.8
• 作者: Dickerson JC;Ragavan MV;Parikh DA;Patel MI
• 通讯作者: Patel MI

The evolving landscape of sex-based differences in lung cancer: a distinct disease in women.

• DOI: 10.1183/16000617.0100-2021
• 发表时间: 2022-03-31
• 期刊: European respiratory review : an official journal of the European Respiratory Society

Health Care Professionals' Perspectives on Implementation, Adoption, and Maintenance of a Community Health Worker-Led Advance Care Planning and Cancer Symptom Screening Intervention: A Qualitative Study.

卫生保健专业人员对社区卫生工作者主导的预先护理计划和癌症症状筛查干预措施的实施、采用和维护的看法：一项定性研究。

• DOI: 10.1200/op.22.00209
• 发表时间: 2023
• 期刊: JCO oncology practice
• 影响因子: 4
• 作者: Patel,ManaliI;Murillo,Ariana;Agrawal,Madhuri;Coker,Tumaini
• 通讯作者: Coker,Tumaini

Characteristics of Patients With ROS1+ Cancers: Results From the First Patient-Designed, Global, Pan-Cancer ROS1 Data Repository.

ROS1 癌症患者的特征：来自第一个患者设计的全球泛癌症 ROS1 数据库的结果。

• DOI: 10.1200/jop.19.00135
• 发表时间: 2020
• 期刊: JCO oncology practice
• 影响因子: 4
• 作者: Parikh,DivyaA;Walia,Guneet;Freeman-Daily,Janet;Hennink,Merel;Tomalia,Tori;Buonanno,Lysa;Goldman,Lisa;Addario,Bonnie;Patel,ManaliI
• 通讯作者: Patel,ManaliI

Defining the clinician's role in mitigating financial toxicity: an exploratory study.

• DOI: 10.1007/s00520-021-05984-6
• 发表时间: 2021-08
• 期刊: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
• 作者: Ragavan M;Parikh D;Patel M
• 通讯作者: Patel M