Pilot Trial of a "Divine Intervention" to Improve End-of-Life Cancer Care for Black Patients

改善黑人癌症临终护理的“神圣干预”试点试验

• 批准号: 10747114
• 负责人: Paul K Maciejewski
• 金额: $ 28.63万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-21 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10747114
• 关键词: Address; Advance Care Planning; Advance Directives; Advanced Malignant Neoplasm; Affect; African American; Agreement; Ambulatory Care; Belief; Black race; Cancer Patient; Caring; Cessation of life; Chaplain; Clinic; Comparison arm; Data; Decision Making; Distant; Distress; Do Not Resuscitate Order; Dose; Eligibility Determination; Failure; Healthcare; Individual; Inpatients; Intensive Care; Intervention; Malignant Neoplasms; Medical; Oncology; Outcome; Outpatients; Palliative Care; Patient-Focused Outcomes; Patients; Personal Satisfaction; Prayers; Provider; Quality of life; Randomized; Randomized, Controlled Trials; Readiness; Religion; Religion and Spirituality; Reporting; Services; Spiritual care; Spirituality; System; Terminal Disease; Visit; Work; arm; black patient; black/white disparity; cancer care; care outcomes; commune; coping; end of life; end of life care; experience; improved; novel; oncology service; oncology trial; pilot trial; post intervention; primary outcome; skills

Project Summary Most advanced cancer patients report that religiousness and/or spirituality (R/S) are important to them, yet most also say that the medical system has not met their R/S needs. Support of dying patients' R/S needs may prove especially beneficial to those who are religious, including African American (hereafter, “black”) patients who often rely heavily on religion to cope with cancer. Healthcare chaplains work within medical systems to provide R/S care. Among advanced cancer patients, visits with healthcare chaplains are associated with patients' peaceful acceptance of terminal illness, which is associated with higher rates of advance care planning (ACP), which in turn has proved an effective way to enhance a dying patient's quality of life and receipt of value-concordant end-of-life (EoL) care. Additionally, preliminary data suggest that healthcare chaplain visits are associated with higher rates of completing do-not-resuscitate (DNR) orders among black advanced cancer patients. At present, healthcare chaplains work predominantly in inpatient settings. Thus, advanced cancer patients in outpatient settings have not benefited from the many positive effects of healthcare chaplaincy, including having unmet spiritual needs addressed and the benefits of incorporating spiritual care into EoL decision-making and the cancer care experience. To date, there has not been a randomized controlled trial (RCT) of effects of early integration of healthcare chaplain-led spiritual care on EoL cancer care. We propose here to determine the feasibility of conducting such a trial and to explore potential effects of healthcare chaplain-led spiritual care on spiritual well-being and readiness to engage in ACP among black advanced cancer patients in outpatient settings. Specifically, we propose: Aim #1: Will determine the feasibility of conducting an RCT of effects of early integration of healthcare chaplain-led spiritual care into outpatient oncology care on EoL care. Aim #2: Will explore potential effects of healthcare chaplain-led spiritual care on spiritual well-being and ACP among black advanced cancer patients in outpatient settings. Aim #3: Will explore potential mechanisms by which healthcare chaplain-led spiritual care in outpatient settings affect black advanced cancer patients' EoL care outcomes. Impact: Results will provide evidence of the feasibility of conducting an RCT of the effects of early outpatient (in advance of a terminal inpatient) healthcare chaplain-led spiritual care on spiritual well-being and ACP among black advanced cancer patients. Integration of healthcare chaplain-led spiritual care into outpatient oncology services for advanced cancer patients may be an impactful, scalable way to improve the EoL cancer care experience among black patients with advanced cancer.

项目总结