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ICU Triage Decisions for Elders with End Stage Cancer: the Role of Patient Race

重症监护病房 (ICU) 对晚期癌症老年人的分诊决策：患者种族的作用

基本信息

批准号：
7799225
负责人：
AMBER E BARNATO
金额：
$ 13.43万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-04-01 至 2013-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7799225
关键词：
Admission activity Affective American Beds Behavior Belief Caucasoid Race Clinical Communication Critical Illness Decision Making Diagnosis Diagnostic Neoplasm Staging Discrimination Disseminated Malignant Neoplasm Elderly Event Family Future Goals Home environment Hospitals Hypoxia Individual Intensive Care Interview Life Malignant Neoplasms Mediating Medical Patient Preferences Patients Performance Physicians Pilot Projects Prejudice Privacy Probability Process Provider Public Health Race Recommendation Role Services Simulate Source Stereotyping Testing Time Triage Uncertainty Variant Work base communication behavior design end of life heuristics human subject protection improved in vivo outcome forecast patient oriented preference psychosocial public health relevance racial difference research study simulation success therapy design

项目摘要

DESCRIPTION (provided by applicant): One in five Americans die using intensive care (ICU) services despite a dominant cultural preference for dying at home. Blacks, especially those with cancer, are more likely to die in an ICU than whites, despite the fact that the majority of black elders have a preference against aggressive end-of-life treatment. For patients with end-stage cancer, seeking or deferring ICU admission is a critical single-event decision. While there is some evidence that blacks may be more likely to prefer aggressive life-sustaining treatment than whites, race-based differences in communication around end-of-life ICU use likely also contribute to existing disparities. Previous studies of physician decision making for common medical conditions have demonstrated race-based differences in diagnosis and treatment, ranging from overt prejudice, stereotyping and discrimination to the application of rules of conditional probability in the context of uncertainty. The goal of the proposed study is to enhance understanding of decision-making processes that impact end-of-life ICU use and factors which contribute to existing racial disparities in end-of-life ICU use. Our three specific aims are: 1) To test the effect of patient race on physician decisions to recommend ICU admission for a patient with end-stage cancer using high-fidelity simulation. 2) To test whether and how patient-provider communication mediates the effect of patient race on physician ICU admission decisions using qualitative content analysis of simulation encounters. 3) To explore the causes of race-based differences in ICU admission decision-making. A better understanding of physicians' decision-making processes and how they may contribute to a mismatch between patient preferences and end-of-life treatment could be used to design interventions to improve physician behavior. Public Health Relevance: The relevance of the proposed project to public health derives from a better understanding of how physicians contribute to racial variations in intensive care use at the end of life. The proposed project will be a success if can document differences in treatment decisions for black versus white simulated patients and generate hypotheses explaining these observed differences. Future work might include testing these hypotheses and developing educational modules for physicians aimed at improving their ability to make patient-centered decisions for critically ill patients with end-stage cancer.

描述（由申请人提供）：五分之一的美国人死于重症监护（ICU）服务，尽管主流文化倾向于在家中死亡。黑人，尤其是那些患有癌症的人，比白人更有可能死于重症监护病房，尽管事实上大多数黑人老人都倾向于反对激进的临终治疗。对于终末期癌症患者，寻求或推迟ICU住院是一个关键的单事件决定。虽然有证据表明，黑人可能比白人更喜欢积极的维持生命的治疗，但围绕临终ICU使用的种族沟通差异也可能导致现有的差距。先前关于医生对常见疾病的决策的研究表明，在诊断和治疗方面存在基于种族的差异，从明显的偏见、刻板印象和歧视到在不确定性背景下应用条件概率规则。拟议研究的目的是加强对影响临终ICU使用的决策过程的理解，以及导致临终ICU使用中存在种族差异的因素。我们的三个具体目标是：1)使用高保真模拟测试患者种族对医生建议晚期癌症患者进入ICU的决定的影响。2)通过模拟会面的定性内容分析，检验医患沟通是否以及如何介导患者种族对医生ICU入院决策的影响。3)探讨ICU住院决策中种族差异的原因。更好地了解医生的决策过程，以及它们如何导致患者偏好和临终治疗之间的不匹配，可以用来设计干预措施，以改善医生的行为。公共卫生相关性：拟议项目与公共卫生的相关性源于更好地理解医生如何促成生命末期重症监护使用的种族差异。如果可以记录黑人和白人模拟患者在治疗决策上的差异，并产生解释这些观察到的差异的假设，那么拟议的项目将是成功的。未来的工作可能包括测试这些假设，并为医生开发教育模块，旨在提高他们为晚期癌症危重患者做出以患者为中心的决策的能力。

项目成果

期刊论文数量（7）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A randomized trial of the effect of patient race on physicians' intensive care unit and life-sustaining treatment decisions for an acutely unstable elder with end-stage cancer.

DOI：
10.1097/ccm.0b013e3182186e98
发表时间：
2011-07
期刊：
Critical care medicine
影响因子：
8.8
作者：
Barnato AE;Mohan D;Downs J;Bryce CL;Angus DC;Arnold RM
通讯作者：
Arnold RM

Physicians' decision-making roles for an acutely unstable critically and terminally ill patient.

DOI：
10.1097/ccm.0b013e318287f0dd
发表时间：
2013-06
期刊：
Critical care medicine
影响因子：
8.8
作者：
Uy J;White DB;Mohan D;Arnold RM;Barnato AE
通讯作者：
Barnato AE

Hospital-Based Physicians' Intubation Decisions and Associated Mental Models when Managing a Critically and Terminally Ill Older Patient.

DOI：
10.1177/0272989x17738958
发表时间：
2018-04
期刊：
Medical decision making : an international journal of the Society for Medical Decision Making
影响因子：
0
作者：
Haliko S;Downs J;Mohan D;Arnold R;Barnato AE
通讯作者：
Barnato AE

Key Physician Behaviors that Predict Prudent, Preference Concordant Decisions at the End of Life.

DOI：
10.1080/23294515.2020.1865476
发表时间：
2021-10
期刊：
AJOB empirical bioethics
影响因子：
0
作者：
Morales A;Murphy A;Fanning JB;Gao S;Schultz K;Hall DE;Barnato A
通讯作者：
Barnato A

Prudence in end-of-life decision making: A virtue-based analysis of physician communication with patients and surrogates.

临终决策的审慎：对医生与患者和代理人沟通的基于美德的分析。

DOI：
10.1016/j.ssmqr.2022.100182
发表时间：
2022
期刊：
SSM. Qualitative research in health
影响因子：
0
作者：
Murphy,AlanC;Schultz,KevanC;Gao,ShaSha;Morales,AndreM;Barnato,AmberE;Fanning,JosephB;Hall,DanielE
通讯作者：
Hall,DanielE