Leveraging behavioral science to improve patient understanding of advanced cancer

利用行为科学提高患者对晚期癌症的了解

• 批准号: 10256058
• 负责人: Heather Derry-Vick
• 金额: $ 0.91万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-07 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10256058
• 关键词: Address; Adherence; Advanced Malignant Neoplasm; Anxiety; Appointment; Area; Award; Behavioral Sciences; Benchmarking; Biofeedback; Biological Markers; Cancer Patient; Cause of Death; Cessation of life; Clinical; Clinical Trials; Code; Communication; Complex; Data; Decision Making; Disease; Disease Progression; Disseminated Malignant Neoplasm; Distress; Educational Intervention; Elements; Emotions; Feedback; Foundations; Goals; Health; Health Psychology; Healthcare; Hearing; Heart Rate; Intervention; Interview; K-Series Research Career Programs; Laboratories; Lead; Leadership; Learning; Link; Malignant Neoplasms; Malignant neoplasm of gastrointestinal tract; Malignant neoplasm of lung; Manuals; Measures; Medical; Medicine; Mentors; Mentorship; Methods; Modeling; Monitor; Observational Study; Oncology; Palliative Care; Pathway interactions; Patient Preferences; Patient Self-Report; Patients; Pattern; Phase; Physicians; Physiological; Play; Positioning Attribute; Process; Prognosis; Psychological Factors; Psychological Stress; Psychologist; Psychophysiology; Public Health; Quality of Care; Quality of life; Randomized; Reaction; Reporting; Research; Research Personnel; Resources; Rest; Role; Scanning; Science; Stable Disease; Stress; Test Result; Testing; Time; Training; Translating; United States; United States National Institutes of Health; Visit; Work; acceptability and feasibility; anticancer research; base; biobehavior; cancer care; career; chemotherapy; coping; end of life; end of life care; experience; health care quality; heart rate variability; improved; indexing; insight; intervention effect; novel strategies; patient oriented; preference; prognostic; programs; psychologic; randomized trial; routine imaging; secondary outcome; skills; statistics; stress management; treatment as usual; treatment response; trial comparing; tumor progression

PROJECT SUMMARY Most advanced cancer patients do not have an accurate understanding of their prognosis and treatment, which interferes with patient-centered, high-quality healthcare. Gaining such information often requires patients to confront stressful clinical discussions while understanding complex medical information. Existing interventions to improve understanding largely target information delivery, without assessing and reducing psychological barriers to hearing prognostic information accurately. This Pathway to Independence Award will equip Dr. Heather Derry with the necessary skills to launch her independent research career, in which she aims to identify and reduce stress-related barriers to informed medical decision-making among patients with cancer. The candidate's prior work suggests that anxiety may reduce patients' accuracy for recently-discussed scan results (used to monitor disease progression and inform treatment). In this career development award, the PI will: (1) solidify targets and methods for a stress management intervention to improve patients' understanding of prognostic information (i.e., scan results), then (2) adapt, revise, and (3) pilot test a stress management program to reduce anxiety prior to key prognostic discussions. At Weill Cornell Medicine's distinguished Center for Research on End-of-Life Care, the PI will receive expert mentorship and complete specialized training in advanced cancer and end-of-life care, intervention adaptation and clinical trials, advanced psychophysiology and statistics, and leadership. In the K99 phase, the PI will conduct an observational study to confirm pilot data linking psychological factors to patient understanding, and investigate vagal tone (measured by heart rate variability) as an underlying physiological mechanism for this pattern. Before an appointment to discuss scan results during first-line treatment, 75 patients with advanced gastrointestinal or lung cancer will complete assessments of resting heart rate and self-reported anxiety, worry, and anticipatory stress. After the appointment, patients will report their understanding of those scan results. Patients' answers will be compared to audio-recorded clinical visits for accuracy. Analyses will test relationships between accuracy, psychological factors, and heart rate variability. Qualitative interviews will elicit patients' preferences for intervention adaptations and delivery methods. In the R00 phase, the PI will use this information to adapt an existing stress management program (a public resource) to mitigate anxiety (and/or other targets) prior to these appointments. Finally, the intervention's feasibility, acceptability, and potential efficacy will be tested in a pilot randomized trial, compared with usual care. Overall, the project will begin to address key psychological and physiological factors missing from prior attempts to improve advanced cancer patients' understanding of prognostic information. Given her prior training and research in health psychology, strong mentorship team, and proposed training plan, Dr. Derry is well-positioned to become an independent investigator in this area, with the overall goal of increasing quality of life and quality of care for people with advanced cancer.

项目总结 大多数晚期癌症患者对自己的预后和治疗没有准确的了解，这 干扰以患者为中心的高质量医疗保健。获取此类信息通常需要患者 面对充满压力的临床讨论，同时了解复杂的医疗信息。现有干预措施 在很大程度上提高对信息传递的理解，而不评估和减少心理上的影响 准确听到预后信息的障碍。这一独立之路奖将为Dr。 希瑟·德里拥有必要的技能来开始她的独立研究生涯，她的目标是 在癌症患者中识别和减少与压力相关的障碍，以进行知情的医疗决策。 这位候选人之前的工作表明，焦虑可能会降低患者对最近讨论的扫描的准确性 结果(用于监测疾病进展和通知治疗)。在这个职业发展奖中，PI 将：(1)确定压力管理干预的目标和方法，以提高患者的理解 预测信息(即，扫描结果)，然后(2)适应、修改，以及(3)试行压力管理 在关键的预后讨论之前减少焦虑的计划。在威尔·康奈尔医学杰出中心 对于临终关怀研究，PI将接受专家指导并完成以下方面的专业培训 晚期癌症和临终关怀、干预适应和临床试验、高级心理生理学 以及统计数据和领导力。在K99阶段，PI将进行观测研究以确认试点数据 将心理因素与患者的理解联系起来，并调查迷走神经张力(以心率衡量 可变性)作为这种模式的潜在生理机制。在预约讨论扫描之前 结果在一线治疗期间，75例晚期胃肠道或肺癌患者将完成治疗 评估静息心率和自我报告的焦虑、担忧和预期压力。后 预约后，患者将报告他们对扫描结果的理解。患者的回答将被比较 到录音的临床访问，以确保准确性。分析将测试准确性、心理和心理之间的关系 因素和心率变异性。定性访谈将引出患者对干预的偏好 改编和交付方法。在R00阶段，PI将使用该信息来适应现有的压力 管理计划(一种公共资源)，在这些任命之前缓解焦虑(和/或其他目标)。 最后，干预措施的可行性、可接受性和潜在疗效将在随机试点中进行测试 审判，与平时的护理相比。总体而言，该项目将开始解决关键的心理和生理问题 改善晚期癌症患者对预后的理解的先前尝试中缺失的因素 信息。鉴于她之前在健康心理学方面的培训和研究，强大的导师团队，并建议 培训计划，德里博士处于有利地位，成为这一领域的独立调查员，总体上 旨在提高晚期癌症患者的生活质量和护理质量。