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/或灵性对他们很重要(R/S)，但 大多数人还表示，医疗制度没有满足他们对R/S的需求。对临终病人R/S需求的支持可能 事实证明，这对那些信教的人特别有益，包括非裔美国人(以下简称“黑人”)患者 他们经常严重依赖宗教来应对癌症。医疗保健牧师在医疗系统内工作以 提供R/S护理。在晚期癌症患者中，去看保健牧师与 患者对绝症的平静接受，这与较高的预治率有关 规划(ACP)，这反过来被证明是提高临终病人生活质量和 接受符合价值的临终关怀(EoL)。此外，初步数据表明，医疗保健 牧师来访与黑人中更高的不复苏(DNR)订单完成率有关 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， 门诊中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 牧师工作，包括解决未得到满足的精神需求和纳入精神关怀的好处 EoL决策和癌症护理经验。到目前为止，还没有随机的 早期整合医疗保健牧师主导的精神护理对EoL癌症护理的影响的对照试验(RCT)。 我们建议在这里确定进行这样一项试验的可行性，并探索 医疗保健牧师领导的对黑人精神福祉和参与非物质文化遗产计划的精神关怀 门诊中的晚期癌症患者。具体地说，我们建议：目标1：将决定 开展一项RCT的可行性研究，以评估早期将牧师引导的精神护理融入 EoL护理的门诊肿瘤科护理。目标2：将探索牧师主导的医疗保健的潜在影响 精神关怀对门诊黑人晚期癌症患者精神幸福感和非物质文化生活质量的影响。 目标3：将探索医疗保健牧师引导门诊患者进行精神护理的潜在机制 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(临终住院患者之前)进行随机对照试验的可行性 医疗保健牧师领导的对黑人晚期癌症患者精神健康和非物质文化遗产的精神关怀。 将牧师主导的精神关怀融入晚期癌症的门诊肿瘤学服务 患者可能是一种有效、可扩展的方式来改善黑人患者的EoL癌症护理体验 癌症晚期。

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.