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

项目摘要 大多数晚期癌症患者报告说，宗教和/或灵性（R/S）对他们很重要，但 大多数人还说，医疗系统没有满足他们的R/S需求。支持垂死病人的R/S需求可能 证明特别有利于那些谁是宗教，包括非裔美国人（以下简称“黑人”）的病人 他们往往严重依赖宗教来科普癌症。医疗保健牧师在医疗系统内工作， 提供R/S护理。在晚期癌症患者中，与医疗保健牧师的访问相关， 病人对绝症的平静接受，这与更高的提前护理率有关 计划（ACP），这反过来又被证明是提高垂死患者生活质量的有效方法， 接受价值一致的生命末期（EoL）护理。此外，初步数据显示， 在黑人中，牧师访问与完成不复苏（DNR）命令的较高比率相关 晚期癌症患者。目前，医疗保健牧师主要在住院环境中工作。因此，在本发明中， 门诊的晚期癌症患者并没有从医疗保健的许多积极作用中受益， 牧师，包括解决未满足的精神需求和纳入精神护理的好处 EoL决策和癌症护理经验。到目前为止，还没有一个随机的 对照试验（RCT）的影响，早期整合的医疗牧师领导的精神护理对EoL癌症护理。 我们建议在此确定进行此类试验的可行性，并探讨 医疗保健牧师领导的精神关怀对精神福祉和准备从事ACP黑人 晚期癌症患者的门诊治疗具体来说，我们建议：目标#1：将确定 进行一项RCT的可行性，研究早期将医疗牧师领导的精神护理整合到 EoL护理的门诊肿瘤护理。目标#2：将探索医疗保健牧师领导的潜在影响 精神关怀对门诊黑人晚期癌症病人精神健康及ACP之影响。 目标#3：将探索潜在的机制，通过这种机制，医疗牧师领导的精神护理门诊 环境影响黑人晚期癌症患者的EoL护理结果。影响：结果将提供证据， 对早期门诊患者的影响进行随机对照试验的可行性（在晚期住院患者之前） 医疗牧师领导的精神护理对黑人晚期癌症患者的精神健康和ACP的影响。 整合医疗牧师领导的精神护理到晚期癌症的门诊肿瘤服务中 患者可能是改善黑人患者EoL癌症护理体验的一种有效、可扩展的方式 晚期癌症患者

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.