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

 描述(申请人提供)：癌症是美国的主要死亡原因，癌症死亡人数正在增加。2014年，医学研究所得出结论，日益激进、负担沉重和昂贵的临终关怀(EoL)是一个需要解决的主要公共卫生问题。普里格森博士的NCI资助的应对癌症(CWC)研究指出，在提供EoL癌症护理方面的问题可能会有强大的心理社会解决方案。这项R35奖项将使她有机会将她自2002年以来一直由NCI资助的多点纵向R01 CWC研究的基础观察性研究成果转化为改善EoL癌症护理的介入试验。在这项研究的第一阶段，普里格森博士将开发必要的研究工具并建设能力，以推进第二阶段的干预开发项目。具体地说，第一阶段项目将侧重于开发和完善量表，以评估EoL癌症护理中心理社会干预的目标和结果，包括a)患者和照顾者处理与预后有关的信息的心理准备(例如，对患者晚期预后的情感接受)；b)患者和照顾者对疾病和EoL治疗选择的理解(即对患者晚期预后和EoL健康素养的认知接受)；以及c)患者在EoL的生活质量(又名死亡质量)。第一阶段项目还将设计和建立数据库，将现有的《化学武器公约》前瞻性队列研究数据和未来的心理社会干预试验数据与联邦医疗保险索赔数据联系起来，以准确、全面地评估心理社会因素和干预措施对EoL癌症护理中卫生服务使用和成本的影响。第二阶段项目将使用这些衡量工具和影响评估来制定心理社会干预措施，其目标是：a)对EoL的疾病和治疗的了解，b)推进护理规划的障碍，c)EoL结果的改善，d)减少EoL结果中的种族、族裔和性别差异。第二阶段项目将开发心理社会干预措施，纳入并加强经过验证的战略，以促进对绝症的情感和认知接受以及对治疗选择的理解，应用“社会验证”的概念来改善EoL临床沟通，并将宗教信仰(如奇迹)与背景联系起来，以减少EoL癌症护理中的差异。这一研究计划有望为EoL癌症研究产生新颖和完善的测量工具，将心理社会因素和干预数据与EoL癌症护理中的全面医疗服务使用和成本数据联系起来并将其联系起来的全面数据集，以及旨在促进所有癌症患者及其家人的理解和更好的EoL结果的心理社会干预措施，而不分种族、民族或性别。

 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.