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: 10580865
• 负责人: Heather Derry-Vick
• 金额: $ 24.9万
• 依托单位: HACKENSACK UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10580865
• 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; Patients; Pattern; Persons; 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; pilot test; preference; prognostic; programs; psychologic; randomized trial; routine imaging; secondary outcome; self-reported anxiety; 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