Communicating with Oncology Nurses about Values from the Outset (CONVO): An Innovative Primary Palliative Care Intervention in English and Espanol

从一开始就价值观与肿瘤科护士沟通 (CONVO)：一种创新的初级姑息治疗干预措施（英语和西班牙语）

• 批准号: 10269930
• 负责人: FRANCESCA M GANY
• 金额: $ 26.55万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10269930
• 关键词: Address; Advance Care Planning; Americas; Articulation; Authorization documentation; Cancer Center; Cancer Patient; Caring; Clinic; Clinical; Communication; Communities; Decision Making; Diagnosis; Disease; Dissemination and Implementation; Effectiveness; Effectiveness of Interventions; Face; Failure; Family; Foundations; Future; Goals; Guidelines; Health; Health Personnel; Hearing; Individual; Intervention; Intervention Trial; Latino; Learning; Life; Linguistics; Malignant Neoplasms; Measures; Medical; Medical Errors; Memorial Sloan-Kettering Cancer Center; Methods; Minority; Minority Groups; Modeling; Nurses; Oncologist; Oncology; Oncology Nurse; Outcome; Outpatients; Palliative Care; Patient Care; Patient-Centered Care; Patients; Personhood; Persons; Phase; Pilot Projects; Population; Process; Prognosis; Protocols documentation; Public Health; Quality of Care; Quality of life; Reporting; Research; Research Design; Research Project Grants; Resources; Site; Specialist; Standardization; Structure; Time; Training; Translating; Trust; Work; base; cancer care; cancer health disparity; cancer therapy; effectiveness outcome; end of life; health care service utilization; high risk; implementation intervention; implementation strategy; improved; informal caregiver; informant; innovation; member; pilot trial; preference; shared decision making; success; treatment as usual

PROJECT SUMMARY Each person facing illness has a unique perspective on what is important/gives meaning/defines acceptable quality of life. This perspective - the individual's health-related values – provides the foundation of patient- centered care. Articulation of values allows the individual to feel heard/respected as a person and to share in medical decision-making. Thus, in cancer care, clinician-patient discussion of values early on is essential even in the context of early stage and/or curable disease. However, existing evidence indicates a compelling need for interventions to improve this communication. Availability of palliative care specialists to help communicate about/align care with values remains limited, especially in outpatient settings. Oncology guidelines and standards call for “primary” palliative care (i.e., by interprofessional oncology teams) as part of cancer care for every patient from time of diagnosis. We have developed an innovative intervention - Communicating with Oncology Nurses about Values from the Outset (CONVO) – that leverages trusting relationships between patients and nurses to incorporate structured, nurse-led discussions of values in routine outpatient oncology care from the beginning, regardless of the patient's cancer stage or prognosis. The nurse summarizes the patient's values, shares this summary with patient and oncologist, includes it in the EHR for all health care providers to review, and encourages the patient to discuss these values with family/other informal caregivers or surrogates. In a pilot study at our dedicated cancer center, the CONVO intervention was feasible and acceptable to patients (mostly non-Latino Whites) and clinicians. We now propose to expand this work outside our center to include Spanish-speaking Latino cancer patients, the largest and fastest-growing minority group in the US, who have been poorly represented in prior research to improve communication around values in cancer. Specific Aims are: 1) To translate/transcreate (linguistic plus cultural adaptation) the CONVO intervention for implementation with Spanish-speaking Latino cancer patients receiving outpatient oncologic care in their communities. 2) To evaluate the feasibility and effectiveness of this intervention as implemented in English and Spanish in different organizational contexts and communities. Latino adaptation of CONVO will use mixed methods in formative and adaptive iterative phases. To evaluate feasibility and effectiveness, we will then conduct a pre-post pilot trial of the intervention in English and Spanish at two community-based oncology clinics where Latinos are strongly represented. The primary effectiveness outcome will be the occurrence of discussion of values (Quality of Communication assessment, validated in English/Spanish) as reported by patients at 6 weeks (± 2-week window) after the timepoint for intervention delivery. This research is significant in extending/evaluating an innovative nurse-led, primary palliative care intervention that can help thousands of patients including minorities receive care aligned with their values, avoid burdensome treatments that do not serve patient goals, and reduce cancer disparities. Results will inform a future large-scale RCT.

项目概要 每个面临疾病的人对于什么是重要的/赋予意义/定义可接受的都有独特的观点 生活质量。这种观点——个人与健康相关的价值观——为患者提供了基础—— 集中护理。价值观的表达让个人感到被倾听/被尊重，并分享 医疗决策。因此，在癌症护理中，临床医生与患者尽早就价值观进行讨论甚至是至关重要的 在早期和/或可治愈疾病的背景下。然而，现有证据表明迫切需要 寻求干预措施来改善这种沟通。姑息治疗专家可以帮助沟通 关于/使护理与价值观保持一致仍然有限，特别是在门诊环境中。肿瘤学指南和 标准要求将“初级”姑息治疗（即由跨专业肿瘤学团队进行）作为癌症护理的一部分 每个患者从诊断时起。我们开发了一种创新的干预措施——与 肿瘤科护士从一开始就价值观 (CONVO) – 利用之间的信任关系 患者和护士在常规门诊中纳入由护士主导的结构化价值观讨论 肿瘤护理从一开始，无论患者的癌症分期或预后如何。护士 总结患者的价值观，与患者和肿瘤科医生分享此摘要，并将其包含在所有人的 EHR 中 医疗保健提供者进行审查，并鼓励患者与家人/其他非正式人士讨论这些价值观 照顾者或代理人。在我们专门的癌症中心进行的一项试点研究中，CONVO 干预是可行的 并且为患者（主要是非拉丁裔白人）和临床医生所接受。我们现在建议扩大这项工作 在我们中心外，包括讲西班牙语的拉丁裔癌症患者，他们是最大且增长最快的少数族裔 美国的一个群体，在之前关于改善价值观沟通的研究中，他们的代表性很低 在癌症中。具体目标是： 1) 翻译/创译（语言加文化适应）CONVO 对接受门诊肿瘤治疗的西班牙语拉丁裔癌症患者实施干预 关心他们的社区。 2) 评估实施该干预措施的可行性和有效性 不同组织环境和社区中的英语和西班牙语。 CONVO 的拉丁语改编将 在形成和适应性迭代阶段使用混合方法。为了评估可行性和有效性，我们 然后将在两个社区以英语和西班牙语进行干预前后试点试验 拉丁美洲裔人口较多的肿瘤诊所。主要有效性结果将是 发生价值观讨论（沟通质量评估，以英语/西班牙语验证） 由患者在干预实施时间点后 6 周（± 2 周窗口）报告。这项研究是 对于扩展/评估创新的护士主导的初级姑息治疗干预措施具有重要意义，该干预措施可以帮助 包括少数族裔在内的数千名患者接受符合其价值观的护理，避免繁重的治疗 这不利于患者的目标，也不会减少癌症差异。结果将为未来的大规模随机对照试验提供信息。