Psychological Responses to the Possibility of Dying: Decision-Making Implications for Advanced Cancer Patients

对死亡可能性的心理反应：对晚期癌症患者的决策影响

• 批准号: 10653708
• 负责人: LOGIN GEORGE
• 金额: $ 24.9万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10653708
• 关键词: Address; Advance Care Planning; Advanced Malignant Neoplasm; Automobile Driving; Cancer Patient; Caregivers; Caring; Categories; Cessation of life; Clinical; Clinical Psychology; Communication; Counseling; Data; Data Analyses; Decision Making; Depressed mood; Development; Distress; Factor Analysis; Family; Foundations; Future; Goals; Grief reaction; Health; Institute of Medicine (U.S.); Intervention; Knowledge; Lead; Life; Life Expectancy; Life Experience; Literature; Malignant Neoplasms; Measurement; Measures; Mechanical ventilation; Medical Oncology; Mentors; Mentorship; Outcome; Palliative Care; Patients; Pattern; Perception; Personal Satisfaction; Persons; Phase; Preparation; Procedures; Process; Prognosis; Prospective Studies; Prospective, cohort study; Psychiatry; Psychologist; Psychology; Psychometrics; Quality of Care; Quality of life; Questionnaires; Race; Religiosity; Research; Resources; Sampling; Science; Severities; Shapes; Terminally Ill; Thinking; Toxic effect; Training; Training Activity; Trauma; Well in self; advanced disease; anticancer treatment; cancer therapy; career; chemotherapy; cognitive testing; coping; end of life; end of life care; expectation; experience; falls; fighting; improved; innovation; novel strategies; peace; prognostic; programs; psychologic; psychological distress; response; skills; social culture; therapy development; tool; treatment duration

Project Summary Among terminally ill advanced cancer patients, an inaccurate understanding of prognosis leads to poor treatment decision-making and end-of-life (EOL) care planning, with far reaching negative effects on patient, familial, and societal outcomes. Existing interventions to address this problem have focused on providing patients more information about their prognosis, but have been largely limited in impact, showing that even when given information, patients tend to be unrealistic and inaccurate in their prognostic understanding. Therefore, there is an urgent need for research and interventions that account for the psychological barriers to better patient understanding and outcomes. The candidate’s career goal is to develop an interdisciplinary program of research at the intersection of psychological science, cancer treatment decision-making, and EOL outcomes, that addresses this need. Accordingly, proposed here is a training plan that bridges his background as a clinical psychologist to EOL research. The candidate has a strong background in research examining the psychological processes by which people integrate major, aversive, life experiences (e.g., trauma) into new life goals and expectations. In the K99/R00 projects, he will apply this well-established literature to how advanced cancer patients reconcile the possibility of dying with their goals and expectations, and how this shapes their understanding, decision-making, and EOL outcomes. He will receive interdisciplinary mentorship from experts in EOL research, decision-making, medical oncology, psychiatry, and measurement science. With their mentorship, he will identify and measure the different types of efforts patients use to reconcile the possibility of dying with goals and expectations (Aim 1; K99 phase). In Aim 2 (R00 phase), the candidate will longitudinally examine the different efforts, to identify which predict better subsequent EOL outcomes, including accurate patient understanding, informed use of anti-cancer treatments, care planning, psychological well-being, receipt of value-consistent care in the final week of life, and post-death impact on caregiver and family. Aims 1 and 2 will thus lead to a valuable tool for use in future research and identify which ways of managing goals and expectations is most optimal for future outcomes. Interventions could then be developed helping patients employ those efforts that best minimize their distress and allow them to make more optimal decisions and plans. Intermingled with the research aims, is a robust set of training activities giving the candidate interdisciplinary expertise in treatment decision-making, EOL outcomes, and psychology, and skills in measurement development and advanced longitudinal data analysis. Such expertise and skills will allow the candidate to develop an impactful, innovate research program leveraging psychological principles to improve decision-making and EOL outcomes in advanced cancer.

项目概要 在晚期癌症患者中，对预后的不准确认识导致预后不佳 治疗决策和临终 (EOL) 护理计划，对患者产生深远的负面影响， 家庭和社会结果。解决这一问题的现有干预措施主要集中于提供 患者获得了有关其预后的更多信息，但其影响在很大程度上有限，这表明即使 当获得信息时，患者对预后的理解往往不切实际且不准确。 因此，迫切需要针对心理障碍进行研究和干预。 更好的患者理解和结果。候选人的职业目标是发展跨学科 心理科学、癌症治疗决策和 EOL 交叉点的研究计划 结果，满足了这一需求。因此，这里提出了一个能够弥补他的背景的培训计划 作为临床心理学家进行 EOL 研究。候选人具有很强的研究背景 人们将主要的、令人厌恶的生活经历（例如创伤）融入新生活的心理过程 目标和期望。在 K99/R00 项目中，他将应用这些成熟的文献来研究如何先进 癌症患者将死亡的可能性与他们的目标和期望相协调，以及这如何影响他们的生活 理解、决策和 EOL 结果。他将接受专家的跨学科指导 EOL 研究、决策、医学肿瘤学、精神病学和测量科学。与他们的 在指导中，他将识别并衡量患者为协调可能性而做出的不同类型的努力 带着目标和期望而死（目标 1；K99 阶段）。在目标 2（R00 阶段）中，候选人将纵向 检查不同的努力，以确定哪些可以更好地预测后续 EOL 结果，包括准确的 患者理解、知情使用抗癌治疗、护理计划、心理健康、收据 生命最后一周的价值一致护理，以及死后对护理人员和家人的影响。目标 1 和 2 因此，这将成为未来研究中使用的一个有价值的工具，并确定管理目标和目标的方法。 期望对于未来的结果来说是最优的。然后可以制定干预措施来帮助患者 采取最大程度地减少他们的痛苦并让他们做出更优化的决定的努力 计划。与研究目标相结合的是一套强有力的培训活动，为候选人提供 治疗决策、EOL 结果和心理学方面的跨学科专业知识以及以下方面的技能： 测量开发和高级纵向数据分析。这些专业知识和技能将使 候选人开发一个有影响力的、创新的研究项目，利用心理学原理来提高 晚期癌症的决策和 EOL 结果。