Behavioral and Psychosocial Effects on Study Outcomes in End-Stage Cancer Treatment (BEST End-Stage Cancer Study)

行为和心理社会对晚期癌症治疗研究结果的影响 (aka最佳晚期癌症研究（Best End-Stage Cancer Study） 项目摘要 尽管在理解和治疗癌症方面取得了巨大进步， 癌症死亡率仍在上升，癌症仍是美国第二大死亡原因。 美国。不仅死于癌症的人数在增加， 死亡人数少得惊人。美国的临终关怀被认为是一场公共卫生危机， 国家医学科学院--这个结论得到了我的团队令人不安的发现的支持。我 研究表明，晚期癌症患者接受化疗令人不安地接近死亡， 晚期癌症患者对他们的预后和EoL的危害一无所知， 治疗，种族/少数民族群体得到显着低劣的EoL癌症护理， 严重的精神痛苦和苦难在很大程度上仍未得到控制。现任杰出研究员 内审办的研究查明并针对心理社会因素，以解决这些问题; 研究结果证明了范式的转变和实践的改变。例如，我们证明：1） “姑息化疗”并不“姑息”，实际上可能弊大于利->突出显示 肿瘤学家需要认识到“过度治疗”的危害， 对他们认为接近死亡的患者进行化疗; 2）肿瘤学家预后沟通可以 提高对患者预后的理解，并导致更知情、价值一致的EoL护理，但 它很少发生，并且无效->我们的Oncolo-GIST方法是一种简单有效的方法 肿瘤学家可以很舒服地传达病人预后的要点; 3）“一个尺寸” 在解决EoL癌症护理中的差异时，“不适合所有人”->我们针对黑人的神圣干预 以病患对医疗的不信任与精神照护需求，作为推动事前照护规划之途径 (ACP)4）心理社会压力是一个重要的影响，尽可能多的结果，EoL 决策->我们针对“经验回避”的EMPOWER心理社会干预， 促进照顾者的心理社会调整和参与ACP。展望未来，内审办将 关注：1）肿瘤学家沟通; 2）癌症差异; 3）心理社会困扰。我会 利用数据、理论以及临床和学术资源（同事和合作者） 在当前内审办的主持下制定，以：改善肿瘤学家提供高质量的EoL 癌症护理;增加其预后披露的频率和有效性;促进癌症 患者的预后理解;确保EoL癌症护理的公平提供;并减少 心理社会困扰的病人和照顾者，以加强他们的心理健康和促进他们的 参与ACP。更新本内审办将使我能够进行研究，帮助确保 垂死的癌症患者及其护理人员获得最高质量的EoL癌症护理。

Behavioral and Psychosocial Effects on Study Outcomes in End-Stage Cancer Treatment (aka, the BEST End-Stage Cancer Study) Project Summary Despite great strides that have been made in the understanding and treatment of cancer, the number of cancer deaths remains on the rise and cancer remains the 2nd leading cause of death in the United States (US). Not only is the number of people dying of cancer increasing, but the quality of those deaths is alarmingly poor. End-of-life (EoL) care in the US has been deemed a public health crisis by the National Academy of Medicine -- a conclusion bolstered by disturbing findings from my group. My research has shown that end-stage cancer patients receive chemotherapy troublingly close to death, that end-stage cancer patients are shockingly uninformed of their prognosis and the harms of EoL treatments, that racial/ethnic minority groups receive dramatically inferior EoL cancer care, and that severe emotional pain and suffering remain largely unchecked. The current Outstanding Investigator Award (OIA) research has identified and targeted psychosocial factors to address these problems; the results have proved paradigm-shifting and practice-changing. For example, we showed that: 1) “palliative chemotherapy” does not “palliate” and may actually do more harm than good -> highlighting the need for oncologists to recognize the harms of “overtreatment” and refrain from prescribing chemotherapy to patients they deem close to death; 2) oncologist prognostic communication can improve patient prognostic understanding and lead to more informed, value-concordant EoL care, but it occurs infrequently, and ineffectively –> our Oncolo-GIST approach as a simple, effective way oncologists can feel comfortable communicating the gist of a patient’s prognosis; 3) that “one size does not fit all” in addressing disparities in EoL cancer care->our Divine Intervention targeting black patients’ medical mistrust and spiritual care needs as a way to promote advance care planning (ACP); 4) that psychosocial distress is an important influence on, as much as outcome of, EoL decision-making->our EMPOWER psychosocial intervention targeting “experiential avoidance” to promote caregiver psychosocial adjustment and engagement in ACP. Going forward, this OIA will focus on: 1) oncologist communication; 2) cancer disparities; and 3) psychosocial distress. I will leverage data, theories,and the clinical and scholarly resources (colleagues and collaborators) developed under the auspices of the current OIA to: improve oncologist delivery of high quality EoL cancer care; increase the frequency and effectiveness of their prognostic disclosures; promote cancer patients’ prognostic understanding; ensure the equitable delivery of EoL cancer care; and reduce psychosocial distress of patients and caregivers to enhance their mental health and promote their engagement in ACP. Renewal of this OIA will enable me to conduct research helping to ensure that dying cancer patients and their caregivers receive the highest quality of EoL cancer care possible.