Evaluation of end-of-life best practices and implementation of a tool to predict near-term death among patients with metastatic breast cancer in an oncology clinic

评估肿瘤诊所转移性乳腺癌患者的临终最佳实践和实施预测近期死亡的工具

• 批准号: 10740340
• 负责人: Emily Miller Ray
• 金额: $ 16.25万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10740340
• 关键词: Evaluation; end; life; best; practices

PROJECT SUMMARY A “good death” is often desired but seldom delivered for patients with cancer. Because oncologists often do not recognize when a patient is near the end of life (EOL), many patients receive aggressive care until death. To remedy this, prognostic tools are needed to identify patients nearing death. How to incorporate these tools into routine cancer care and use them to prompt best practices, such as serious illness conversations and hospice referrals, is not well understood. The long-term goal is to leverage evidence-based tools to improve EOL care for patients with metastatic breast cancer (MBC). The main objective is to integrate a validated breast cancer prognostic tool into routine practice using implementation science. This research study will pursue three aims: 1) Define the baseline frequency of documented serious illness conversations and hospice referrals among patients with metastatic breast cancer and their relationship to prognostic risk scores; 2) Co-design an implementation protocol with patient, caregiver, and care team partners for use of a metastatic breast cancer prognostic tool in an oncology clinic; and 3) Pilot implementation of a metastatic breast cancer prognostic tool in an oncology clinic and assess implementation outcomes. For the first aim, a retrospective study using EHR data from patients with MBC will quantify baseline EOL best practices and define their relationship to prognostic scores. For the second aim, interviews and user-centered research with oncologists, patients, and caregivers will evaluate factors that impede or enable implementation of the tool in practice and identify desired features of the prognostic tool implementation. These key partners will co-design an implementation protocol. For the third aim, the tool will be piloted in an oncology clinic according to the protocol and evaluated for implementation outcomes using surveys, interviews, and secondary data in a mixed method design. This project seeks to innovate by shifting the paradigm from sole reliance on clinician judgement towards use of evidence-based tools to estimate prognosis. The proposed study is significant for its potential to improve EOL quality for patients with MBC through timely identification of high-risk patients and earlier initiation of EOL best practices. This proposal is submitted by Emily Ray, MD, MPH, a breast medical oncologist and health services researcher at the University of North Carolina in the Cancer Outcomes Research Program. The proposed career development plan will equip her with skills in implementation science, mixed methods, cancer care quality, and multi-site trials to accelerate her research from its evidence basis in large datasets towards interventions aimed at improving cancer care quality. The academic environment at the University of North Carolina, with leading programs in breast oncology, cancer outcomes research, and public health, and her outstanding mentoring team including Dr. Jennifer Leeman, a well-funded, national expert in implementation science, positions Dr. Ray to make an impact through designing, testing, and implementing evidence-based interventions to deliver high-quality, patient-centered end-of-life cancer care.

项目摘要 癌症患者往往希望有一个“好的死亡”，但很少能实现。因为肿瘤学家通常不会 当患者接近生命末期（EOL）时，许多患者接受积极的护理直到死亡。到 为了补救这一点，需要预后工具来识别濒临死亡的患者。如何将这些工具整合到 常规癌症护理，并利用它们来促进最佳实践，如严重疾病对话和临终关怀 转介，并没有得到很好的理解。长期目标是利用循证工具改善EOL护理 转移性乳腺癌（MBC）患者。主要目的是整合一个有效的乳腺癌 使用实施科学将预测工具纳入常规实践。这项研究将追求三个目标： 1)定义记录的严重疾病对话和临终关怀转诊的基线频率， 转移性乳腺癌患者及其与预后风险评分的关系; 2）共同设计和评估 与患者、护理者和护理团队合作伙伴一起使用转移性乳腺癌的实施方案 肿瘤临床中的预后工具;以及3）转移性乳腺癌预后工具的试点实施 并评估实施结果。对于第一个目标，使用EHR的回顾性研究 MBC患者的数据将量化基线EOL最佳实践，并定义其与 预后评分。对于第二个目标，采访和以用户为中心的研究与肿瘤学家，病人， 护理人员将评估在实践中阻碍或实现工具实施的因素，并确定所需的 预测工具实施的特点。这些主要合作伙伴将共同设计一项实施议定书。 对于第三个目标，该工具将根据方案在肿瘤诊所进行试点，并进行评估， 在混合方法设计中使用调查、访谈和二手数据的实施结果。这 该项目旨在通过将范式从单纯依赖临床医生的判断转变为使用 以证据为基础的工具来估计预后。该研究对于改善EOL具有重要意义 通过及时识别高风险患者和尽早启动EOL， 实践这份提案是由艾米丽雷，医学博士，公共卫生硕士，乳腺肿瘤医学和健康服务 北卡罗来纳州大学癌症结果研究项目的研究员。拟议 职业发展计划将使她具备实施科学，混合方法，癌症护理等方面的技能 质量和多中心试验，以加速她的研究，从大型数据集的证据基础， 旨在提高癌症护理质量的干预措施。北方大学的学术环境 卡罗莱纳在乳腺肿瘤学、癌症结果研究和公共卫生领域拥有领先的项目， 杰出的指导团队，包括Jennifer Leeman博士，一位资金充足的国家执行专家 雷博士通过设计、测试和实施循证医学， 干预措施，以提供高质量，以患者为中心的临终癌症护理。