Optimizing Palliative and End of Life Care for Patients with Cancer

优化癌症患者的姑息治疗和临终关怀

• 批准号: 8764518
• 负责人: Jennifer Sue Temel
• 金额: $ 14.73万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-08 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8764518
• 关键词: Advanced Malignant Neoplasm; American Society of Clinical Oncology; Award; Behavioral Medicine; Cancer Center; Caring; Chest; Clinical; Clinical Investigator; Collaborations; Commit; Communication; Data; Decision Making; Development Plans; Diagnosis; Discipline; Disease; Education; Elements; Ensure; Environment; Faculty; Family; Fellowship; Fellowship Program; Funding; Future; General Hospitals; Goals; Guidelines; Head and Neck Cancer; Health; Hematologic Neoplasms; Hematology; Hospitals; Individual; Institution; Intervention; Leadership; Learning; Life Expectancy; Malignant Neoplasms; Massachusetts; Medical; Medical Oncologist; Medical Oncology; Mentored Clinical Scientist Development Program; Mentors; Mentorship; Mid-Career Clinical Scientist Award (K24); Modeling; Outcome; Outcome Measure; Outcomes Research; Outcomes and Health Services Research; Outpatients; Palliative Care; Patient Care; Patient Outcomes Assessments; Patients; Peer Review; Population; Process; Process Measure; Productivity; Publications; Qualifying; Qualitative Methods; Quality of life; Randomized; Research; Research Personnel; Residencies; Resources; Role; Site; Supportive care; Symptoms; Techniques; Testing; Thoracic Oncology; Time; Training; Training Programs; Universities; cancer care; cancer therapy; career; career development; design; end of life; end of life care; evidence base; experience; gastrointestinal; improved; infancy; innovation; malignant breast neoplasm; medical schools; multidisciplinary; next generation; novel; oncology; outcome forecast; palliative; patient oriented research; patient population; prognostic; programs; psychologic; shared decision making; skills; therapy development; tool

DESCRIPTION (provided by applicant): The long-term objectives of this K24 proposal are to enhance my research productivity and develop new skills in patient-oriented research as well as provide mentorship to increase the number of well-trained clinical investigators capable of providing future mentorship in palliative and end-of-life care. Candidate: As a medical oncologist in thoracic oncology, I am acutely aware of the suffering experienced by patients with advanced cancers and their families. The focus of my research is on developing and testing interventions to improve the quality of life and comprehensive cancer care for patients and their families. I have a strong record of patient-oriented research in palliative and end-of-life care, independent peer-reviewed funding, high quality original publications and effective mentoring. My experience as both a primary research mentor and as Fellowship Director of the Hematology/Oncology training program at my institution over the last seven years has prepared me to expand my mentoring in patient-oriented research. I will substantially alter my current roles and responsibilities to dedicate 50% effort to augment my research program and activities, with a minimum of 25% effort dedicated exclusively to mentoring. I will step down as Fellowship Director (30% effort) to invest time in learning additional research skills and serving new roles i research leadership and mentoring. Environment: The environment at Massachusetts General Hospital (MGH) Cancer Center is ideally suited to support my goals of enhancing my research and mentoring productivity in order to expand the pool of well- trained clinical investigators. The Cancer Center has welcomed and supported the formation of collaborations with palliative care, psycho-oncology, and behavioral medicine to accommodate my novel research program in palliative and end-of-life care. Notably, the Cancer Center has endorsed a new Cancer Outcomes Research Program, under my direction, with the goal of providing mentorship and support to fellows and junior faculty in health services and outcomes research. Additionally, I have access to incredibly talented trainees from Harvard University and Medical School, Harvard-affiliated residency programs, the Dana-Farber/MGH Hematology/Oncology fellowship program, the MGH Behavioral Medicine Program and junior faculty at MGH. Research: My research focuses on evaluating models of integrated palliative and oncology care as well as enhancing clinician-patient communication about end-of-life care. The new projects proposed in this K24 award build on my research in integrated palliative care to study key elements of palliative care communication, communication differences between palliative and oncology care, and the relationship between shared decision-making and patients' end-of life care outcomes. These analyses will allow us to define the roles for palliative care and oncology clinicians to provide optimal care for patients with advanced cancers and to develop data-driven guidelines for best practices and educational programs. The new research in this application also seeks to expand the scope of palliative and supportive care research to patient populations with somewhat better prognosis than those typically included in palliative care studies. These projects offer significant opportunities for mentees to learn how to develop, implement, and test palliative and supportive care interventions. Immediate and Long-Term Career Goal: My immediate career goal is to enhance my productivity and mentoring efforts in patient-oriented research in palliative and end-of-life care. This K24 proposal coincides with a plan to restructure substantially my current responsibilities as I step down as Fellowship Director and take on new roles as Director of the newly-established Cancer Outcomes Research Program and as mentor for the MGH Cancer Center K12 Program. My long-term career goal is to be at the forefront of palliative and end-of-life care research that establishes evidence-based standards for providing comprehensive cancer care, while mentoring the next generation of clinical investigators. This field of intervention development to improve the experience of patients and their families and enhance patient-clinician communication is in its infancy. To enable this program of research to flourish, I strive to conduct the highest quality patient-oriented studies and mentor junior investigators, with the aim of improving the quality of life and care for individuals impacted by cancer. Key Elements of the Research Career Development Plan: My career development plan includes a training strategy to ensure that the K24 award augments my patient-oriented research and mentoring goals. Specifically, I will collaborate with two of the nation's leading communication experts, learn new skills in qualitative methods and medical decision-making, and complete on-site training with experts in palliative care intervention development and education. The training plan will substantially add to my current research skills by enabling me to study the communication techniques used palliative care clinicians and how their approach differs from communication by oncology clinicians. I will also train in medical decision-making to investigate the relationship between shared decision-making and patients' decisions about care at the end of life.

描述（由申请人提供）：本 K24 提案的长期目标是提高我的研究生产力并开发以患者为导向的研究的新技能，并提供指导以增加训练有素的临床研究人员的数量，这些临床研究人员能够在姑息治疗和临终关怀方面提供未来的指导。候选人：作为一名胸部肿瘤内科医生，我敏锐地意识到晚期癌症患者及其家人所经历的痛苦。我的研究重点是开发和测试干预措施，以改善患者及其家人的生活质量和全面的癌症护理。我在姑息治疗和临终关怀领域以患者为中心的研究、独立的同行评审资金、高质量的原创出版物和有效的指导方面拥有良好的记录。过去七年里，我在我的机构中担任主要研究导师和血液学/肿瘤学培训项目的研究员主任，这使我为扩大以患者为导向的研究的指导做好了准备。我将大幅改变我目前的角色和职责，将 50% 的精力用于增强我的研究计划和活动，其中至少 25% 的精力专门用于指导。我将辞去研究员职务（30％的努力），投入时间学习额外的研究技能并担任研究领导和指导方面的新角色。环境：麻省总医院 (MGH) 癌症中心的环境非常适合支持我提高研究和指导生产力的目标，以扩大训练有素的临床研究人员队伍。这 癌症中心欢迎并支持与姑息治疗、心理肿瘤学和行为医学建立合作，以适应我在姑息治疗和临终关怀方面的新颖研究项目。值得注意的是，癌症中心在我的指导下批准了一项新的癌症结果研究计划，其目标是为卫生服务和结果研究方面的研究员和初级教师提供指导和支持。此外，我还可以接触到来自哈佛大学和医学院、哈佛大学附属住院医师项目、达纳法伯/麻省总医院血液学/肿瘤学奖学金项目、麻省总医院行为医学项目和麻省总医院初级教师的才华横溢的学员。研究：我的研究重点是评估综合姑息治疗和肿瘤治疗的模式，以及加强临床医生与患者关于临终关怀的沟通。 K24 奖项中提出的新项目以我在综合姑息治疗方面的研究为基础，旨在研究姑息治疗沟通的关键要素、姑息治疗和肿瘤治疗之间的沟通差异，以及共同决策与患者临终护理结果之间的关系。这些分析将使我们能够定义姑息治疗和肿瘤临床医生的角色，为晚期癌症患者提供最佳护理，并为最佳实践和教育计划制定数据驱动的指南。本申请中的新研究还试图将姑息治疗和支持性护理研究的范围扩大到比姑息治疗研究中通常包含的患者预后更好的患者群体。这些项目为学员提供了学习如何制定、实施和测试姑息性和支持性护理干预措施的重要机会。近期和长期职业目标：我的近期职业目标是提高我的工作效率和在姑息治疗和临终关怀领域以患者为导向的研究方面的指导工作。这项 K24 提案与重组计划不谋而合 当我辞去奖学金主任的职务并担任新成立的癌症结果研究项目的主任和 MGH 癌症中心 K12 项目的导师时，这基本上是我目前的职责。我的长期职业目标是站在姑息治疗和临终关怀研究的最前沿，为提供全面的癌症护理建立循证标准，同时指导下一代临床研究人员。这一旨在改善患者及其家人的体验并加强患者与临床医生沟通的干预措施发展领域尚处于起步阶段。为了使该研究项目蓬勃发展，我努力进行最高质量的以患者为导向的研究并指导初级研究人员，旨在提高受癌症影响的个人的生活质量和护理质量。研究职业发展计划的关键要素：我的职业发展计划包括一项培训策略，以确保 K24 奖项增强我以患者为导向的研究和指导目标。具体来说，我将与两位全国领先的传播专家合作，学习定性方法和医疗决策方面的新技能，并与姑息治疗干预开发和教育方面的专家一起完成现场培训。该培训计划将使我能够研究姑息治疗临床医生使用的沟通技术以及他们的方法与肿瘤临床医生的沟通有何不同，从而大大提高我当前的研究技能。我还将接受医疗决策方面的培训，以研究共同决策与患者临终护理决策之间的关系。