Palliative Care for High-Grade Glioma

高级别胶质瘤的姑息治疗

基本信息

批准号：
10455638
负责人：
Rita Caroline Crooms
金额：
$ 16.9万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-01 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10455638
关键词：
Address Adult Advance Care Planning Affect Age Aging American Society of Clinical Oncology Attitude Cancer Patient Caregiver support Caregivers Caring Certification Cessation of life Clinical Communication Complex Continuity of Patient Care Development Plans Diagnosis Disease Distress Elderly Ensure Equilibrium Ethics European Family Foundations Future Geriatrics Glioma Goals Headache Health Care Costs Impaired cognition Incidence Interview K-Series Research Career Programs Knowledge Learning Life Expectancy Literature Malignant - descriptor Malignant Neoplasms Malignant neoplasm of brain Measures Medical Records Mentors Modeling Morbidity - disease rate National Comprehensive Cancer Network Nausea Neurobehavioral Manifestations Neurologic Neurologic Symptoms Nociception Oncologist Oncology Pain Palliative Care Palliative Medicine Patient Care Patients Pattern Perception Persons Primary Brain Neoplasms Principles of law and justice Process Prognosis Provider Psychosocial Assessment and Care Qualitative Methods Qualitative Research Quality of life Randomized Controlled Trials Religion and Spirituality Research Research Methodology Research Personnel Rotation Seizures Service delivery model Services Societies Source Specialist Structure Symptoms System Time Training Vulnerable Populations Work base cancer palliative treatment cancer therapy care delivery care providers care systems career career development cohort common symptom cultural competence data registry design end of life end of life care experience falls functional decline health care delivery health care service utilization human old age (65+)implementation science improved medical specialties multidisciplinary neoplasm registry older patient palliative physical symptom preference prevent psychologic psychological symptom psychosocial satisfaction service delivery shared decision making skills social stem symptom management symptomatic improvement treatment planning

项目摘要

Brief Summary WHO Grade III and IV gliomas (high-grade glioma or HGG) are aggressive, malignant primary brain tumors that are devastating for older adult patients and caregivers due to high symptom burden, early physical and cognitive decline, caregiver support needs, and existential distress stemming from life expectancy on the order of months. Palliative care, defined by the National Quality Forum as “patient and family-centered care that optimizes quality of life by anticipating, preventing, and alleviating suffering across the continuum of a patient's illness”, is well-suited to meet the complex needs of these patients. Multiple oncological societies recommend that palliative care be integrated early (within 3 months of diagnosis) into the treatment plan of all cancer patients. Older adults have particularly high palliative care needs, in part due to shorter prognosis and decreased tolerance for standard cancer-directed therapy. Generally, palliative care needs may be addressed through a combination of primary palliative care (delivered by any front-line provider, including neuro- oncologists) and/or specialty palliative care (delivered by a provider or multidisciplinary team with advanced palliative care training and certification). The current literature suggests that patients with HGG do not have all their palliative care needs met through primary palliative care from neuro-oncologists, yet they also are not referred to specialty palliative care until they are actively dying. There is no established model for ensuring their palliative care needs are met throughout the disease course. In this proposal, I present a conceptual model of the barriers to comprehensive, timely palliative care for patients with HGG. My career goal is to improve the delivery of palliative care for older adults with HGG. In this proposal I will: 1) use qualitative methods to assess the range of knowledge, experience, and strength of preferences of older adults with HGG, their caregivers, neuro-oncologists, and palliative medicine specialists regarding the domains of palliative care and the optimal balance of primary and specialty palliative care for each domain; 2) use an existing cohort of patients with HGG from a large health delivery system to measure the extent to which services or care processes in each palliative care domain are delivered, and to analyze the associations between palliative care delivery and overall HGG health care utilization. These two projects will be combined with my career development plan, for which I have identified a team of expert mentors and advisors and am proposing coursework relating to qualitative research methods and implementation science, as well as clinical rotations and didactic learning about core concepts in geriatrics and aging research. This will set me on a path to obtain a future career development award, which is the first step on my path to becoming an independent investigator whose work improves the care of older adults with HGG.

简要摘要 WHO III级和IV胶质瘤（高级神经胶质瘤或HGG）是侵略性的，恶性的原发性脑肿瘤由于伯恩伯恩（Burnen）高症状，早期身体和认知能力下降，护理人员的支持需求以及现有的遇到命令预期寿命的困扰几个月。姑息治疗，由国家质量论坛定义为“耐心和以家庭为中心的护理通过预测，预防，预防和减轻患者连续性的痛苦来优化生活质量疾病”非常适合满足这些患者的复杂需求。推荐多个肿瘤社会姑息治疗及早（在诊断后的3个月内）纳入所有癌症的治疗计划患者。老年人的姑息治疗需求特别高，部分原因是预后较短和标准癌症指导治疗的公差降低。通常，可以解决姑息治疗需求通过主要的姑息治疗（由任何一线提供商提供，包括神经 - 肿瘤学家）和/或专业姑息治疗（由提供者或多学科团队提供高级姑息治疗培训和认证）。目前的文献表明，HGG患者没有全部他们的姑息治疗需求是通过神经肿瘤学家的初级姑息治疗满足的，但他们也不是提到专业姑息治疗，直到积极死亡。没有确保的既定模型在整个疾病过程中，他们的姑息治疗需求得到满足。在此提案中，我提出了一个概念 HGG患者的全面，及时姑息治疗的障碍模型。我的职业目标是改善HGG的老年人的姑息治疗。在此提案中，我将：1）使用定性评估HGG老年人偏好的知识，经验和强度范围的方法，他们的护理人员，神经肿瘤学家和姑息医学专家有关姑息治疗领域以及每个领域的初级和专业姑息治疗的最佳平衡； 2）使用现有的队列来自大型健康分娩系统的HGG患者，以衡量服务或护理的程度每个姑息治疗领域的过程都可以交付，并分析姑息治疗之间的关联交付和总体HGG医疗保健利用。这两个项目将与我的职业相结合发展计划，我已经确定了一组专家导师和顾问团队，并正在提议与定性研究方法和实施科学以及临床轮换有关的课程工作以及关于老年医学和衰老研究中核心概念的教学学习。这将使我走上一条途径未来的职业发展奖，这是我成为独立调查员之路的第一步他们的工作改善了HGG的老年人的照顾。