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.

项目总结 每个面对疾病的人对什么是重要的/赋予意义/定义是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-提供了患者- 集中护理。价值观的表达允许个人感受到作为一个人被倾听/被尊重，并分享 医疗决策。因此，在癌症护理中，临床医生和患者在早期讨论价值甚至是必不可少的。 在早期和/或可治愈疾病的背景下。然而，现有的证据表明，迫切需要 进行干预以改善这种沟通。是否有姑息治疗专家来帮助沟通 关于/使护理与价值观保持一致仍然是有限的，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)作为癌症治疗的一部分 每一位患者从确诊之时起。我们开发了一种创新的干预手段--与 肿瘤学护士从一开始就关注价值观(CORUO)-利用 患者和护士在常规门诊中纳入有组织的、由护士主导的价值观讨论 肿瘤学从一开始就进行护理，无论患者的癌症分期或预后如何。护士 总结患者的价值观，与患者和肿瘤学家分享此摘要，并将其包含在EHR中 医疗保健提供者回顾并鼓励患者与家人/其他非正式人士讨论这些价值观 照顾者或代孕母亲。在我们专门的癌症中心进行的一项初步研究中，康普科干预是可行的。 患者(主要是非拉丁裔白人)和临床医生可以接受。我们现在提议扩大这项工作。 在我们中心之外，包括说西班牙语的拉丁裔癌症患者，这是规模最大、增长最快的少数族裔 在美国，他们在以前的研究中表现不佳，以改善围绕价值观的沟通 在癌症中。具体目标是：1)翻译/翻译(语言和文化适应)对话 西语拉丁裔癌症患者接受肿瘤门诊治疗的干预措施 在他们的社区中提供关怀。2)评估#年实施的干预措施的可行性和有效性 在不同的组织背景和社区中使用英语和西班牙语。拉丁语改编的康普罗遗嘱 在形成性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 然后将在两个社区进行英语和西班牙语干预的事后试点试验 拉美裔占多数的肿瘤科诊所。主要的有效性结果将是 价值观讨论的发生(沟通质量评估，以英语/西班牙语验证)为 由患者在干预交付时间点后6周(±2周窗口)报告。这项研究是 在扩展/评估护士主导的创新型初级姑息护理干预措施方面具有重要意义 包括少数族裔在内的数千名患者接受与他们的价值观一致的护理，避免繁重的治疗 这不符合患者的目标，并减少了癌症差异。结果将为未来的大规模随机对照试验提供信息。