Psychosocial Approaches to Better Understanding & End-Stage Cancer Care (PROTECT)

更好地理解的社会心理方法

• 批准号: 9188673
• 负责人: Holly Gwen Prigerson
• 金额: $ 23.03万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9188673
• 关键词: Advance Care Planning; Award; Cancer Patient; Caregivers; Caring; Cause of Death; Cessation of life; Clinical; Cognitive; Cohort Studies; Communication; Data; Data Set; Databases; Development; Emotional; Ethnic Origin; Family member; Funding; Future; Gender; Health; Impact evaluation; Institute of Medicine (U.S.); Intervention; Intervention Trial; Link; Malignant Neoplasms; Measurement; Medicare claim; Observational Study; Outcome; Patients; Phase; Psychosocial Factor; Public Health; Quality of life; Race; Readiness; Religious Belief; Research; Site; Staging; Terminal Disease; Translating; United States; anticancer research; cancer care; coping; cost; disparity reduction; end of life; ethnic disparity; gender disparity; health literacy; health service use; improved; information processing; novel; outcome forecast; programs; prospective; psychologic; psychosocial; quality of death; racial disparity; social; therapy development; tool

 DESCRIPTION (provided by applicant): Cancer is a leading cause of death in the United States and the number of cancer deaths is growing. In 2014, the Institute of Medicine concluded that increasingly aggressive, burdensome and expensive end-of-life (EoL) care was a major public health problem that needed to be fixed. Dr. Prigerson's NCI-funded Coping with Cancer (CwC) studies point to potentially powerful psychosocial solutions to problems in the delivery of EoL cancer care. This R35 award will afford her the opportunity to translate the foundational observational research findings from her multi-site, longitudinal R01 CwC studies, funded continuously by NCI since 2002, into interventional trials to improve EoL cancer care. In Phase I of this program of research, Dr. Prigerson will develop the necessary research tools and build the capacity to advance the intervention development projects in Phase II. Specifically, Phase I projects will focus on the development and refinement of scales to assess targets and outcomes of psychosocial interventions in EoL cancer care, including a) patient and caregiver psychological readiness to process information communicated about prognosis (e.g., emotional acceptance of the patient's terminal prognosis); b) patient and caregiver understanding of illness and EoL treatment options (aka cognitive acceptance of the patient's terminal prognosis and EoL health literacy); and c) the patient's quality of life at the EoL (aka quality of death). PhaseI projects will also devise and establish databases that link existing CwC prospective cohort study data, and future psychosocial intervention trial data, to Medicare claims data to perform accurate, comprehensive evaluations of the impact of psychosocial factors and interventions on health service use and costs in EoL cancer care. Phase II projects will use these measurement tools and impact assessments to develop psychosocial interventions that target: a) illness and treatment understanding at the EoL, b) barriers to advance care planning, c) improvements in EoL outcomes, and d) reduction of racial, ethnic and gender disparities in EoL outcomes. Phase II projects will develop psychosocial interventions that incorporate and enhance proven strategies to promote emotional and cognitive acceptance of terminal illness and understanding of treatment options, apply notions of "social proofing" to improve EoL clinical communication, and contextualize religious beliefs (e.g., in miracles) to reduce disparities in EoL cancer care. This program of research is expected to yield novel and refined measurement tools for EoL cancer research, comprehensive datasets that link and relate psychosocial factors and interventions data to comprehensive health service use and costs data in EoL cancer care, and psychosocial interventions to promote understanding and better EoL outcomes for all cancer patients and their family members, regardless of their race, ethnicity or gender.

 描述（由申请人提供）：癌症是美国的首要死因，并且癌症死亡人数正在不断增加。 2014 年，医学研究所得出结论，日益激进、繁琐且昂贵的临终 (EoL) 护理是一个需要解决的主要公共卫生问题。 Prigerson 博士的 NCI 资助的应对癌症 (CwC) 研究指出，对于临终癌症护理中的问题，可能存在强大的社会心理解决方案。该 R35 奖项将使她有机会将其多中心、纵向 R01 CwC 研究（自 2002 年以来由 NCI 持续资助）的基础观察研究成果转化为干预试验，以改善临终癌症护理。在该研究计划的第一阶段，普里格森博士将开发必要的研究工具并建立能力以推进第二阶段的干预开发项目。具体而言，第一阶段项目将重点关注量表的开发和完善，以评估临终癌症护理中心理社会干预的目标和结果，包括： b) 患者和护理人员对疾病和临终治疗方案的理解（又名对患者终末预后的认知接受和临终健康素养）； c) 患者临终时的生活质量（又称死亡质量）。第一阶段项目还将设计和建立数据库，将现有的 CwC 前瞻性队列研究数据和未来的心理社会干预试验数据与医疗保险索赔数据联系起来，以对心理社会因素和干预措施对卫生服务使用和 EoL 癌症护理成本的影响进行准确、全面的评估。第二阶段项目将使用这些测量工具和影响评估来制定心理社会干预措施，目标是：a）终止生命时的疾病和治疗理解，b）预先护理计划的障碍，c）终止生命结果的改善，以及d）减少终止生命结果中的种族、民族和性别差异。第二阶段项目将开发社会心理干预措施，纳入和加强行之有效的策略，以促进对绝症的情感和认知接受以及对治疗方案的理解，应用“社会证明”的概念来改善临终临床沟通，并将宗教信仰（例如奇迹）置于背景中，以减少临终癌症护理中的差异。该研究计划预计将为 EoL 癌症研究提供新颖和完善的测量工具，将心理社会因素和干预数据与 EoL 癌症护理中的综合卫生服务使用和成本数据联系起来的综合数据集，以及心理社会干预措施，以促进所有癌症患者及其家人（无论其种族、民族或性别）的理解和更好的 EoL 结果。