Project 2: EL CENTRO: Engaging Latinos in the Center of Cancer Treatment Options

摘要：这项研究的目的是提高晚期癌症护理和治疗的质量 通过开发量身定制的视频干预来更好地告知患者他们的 疾病、预后和化疗的风险/益处。患有不治之症的拉丁裔人明显乐观 对预后的预期，经常接受姑息化疗，而不知道这是不可能的 解药。这种误解在拉丁裔中比白人中更普遍，可能会导致 拉美裔/非拉丁裔临终关怀(EOL)方面的差异，例如较低的提前护理计划率， 临终关怀未得到充分利用，临终关怀力度加大。拉丁裔晚期癌症患者面临艰巨的挑战 获取有关其疾病和治疗的关键信息的文化、语言和结构障碍 选择。然而，增进拉美裔人理解的干预措施很少，而且不发达。在.之前 在开始治疗时，肿瘤学家通常会讨论化疗的风险和好处，然后患者会签署 书面知情同意书。这项建议将化疗知情同意(IC)程序作为一种 这是一个战略机遇，使拉美裔人更好地了解他们的疾病和治疗选择。在之前 Schrag博士和Enzinger博士(DF/HCC)开发了一套视频和小册子来支持IC for Common 用于治疗晚期胃肠道癌症的化疗方案平衡了风险和益处，提供了 关于潜在癌症的背景，并包括患者的声音。利用Lindsay博士的(波士顿大学) 在拉丁裔社区参与、混合方法研究和拉丁裔健康差异方面的技能，团队将 改编视频以满足拉美裔人的需求--既有说西班牙语的，也有说英语的。目标1)这项研究 团队将使用四个阶段的定性研究过程，以确保IC工具满足信息、文化、 以及患有晚期胃肠道癌症的拉丁裔人的语言需求。在AIMS 2和3)中产生的西班牙语-英语套装 将测试IC工具，以确定其对拉丁裔患者和照顾者关于癌症的决策的影响 治疗和生命周期护理，以及他们对沟通过程和癌症护理的满意度。这将是 通过一项多中心随机试验完成，该试验涉及116名患有晚期胃肠道癌症的拉丁裔患者和他们的 护理员，从七个学术和社区癌症中心招募，服务于不同的拉丁裔 人口。这种干预是实用的，可扩展的，并具有巨大的潜力来影响癌症的质量 为拉美裔人提供的护理。该项目与U54伙伴关系保持一致，其目标是通过以下方式减少癌症差异 改善与拉丁裔的沟通。该项目优先考虑拉美裔学生的参与，以培养下一代 生成URM研究人员，并更充分地将研究与 更广泛的拉丁裔社区。最后，该项目与拉美裔社区建立和巩固了关系，并 利用其DF/HCC和UMassBoston调查人员的互补专业知识，从而奠定了 为跨领域癌症差异研究建立可持续的伙伴关系奠定基础。

Summary: The objective of the study is to improve the quality of advanced cancer care and treatment decision-making for Latinos by developing a tailored video intervention to better inform patients about their illness, prognosis, and chemotherapy risks/benefits. Latinos with incurable cancer harbor markedly optimistic expectations of prognosis, and often receive palliative chemotherapy without understanding that it is unlikely to cure. Such misconceptions are much more prevalent among Latinos than Whites, and may contribute to Latino/non-Latino disparities in end-of-life (EOL) care such as lower rates of advance care planning, underutilization of hospice and greater intensity of EOL care. Latino advanced cancer patients face formidable cultural, linguistic, and structural barriers to accessing critical information about their disease and treatment options. Nevertheless, interventions to enhance Latinos' understanding are few and underdeveloped. Prior to starting treatment, oncologists typically discuss the risks and benefits of chemotherapy, and patients sign written informed consent. This proposal capitalizes on the chemotherapy informed consent (IC) process as a strategic opportunity to equip Latinos with a better understanding of their illness and treatment options. In prior work, Drs. Schrag and Enzinger (DF/HCC) developed a suite of videos and booklets to support IC for common chemotherapy regimens used to treat advanced GI cancers, which balance attention to risks and benefits, offer context about the underlying cancer, and include patient voices. Leveraging Dr. Lindsay's (UMass Boston) skills in Latino community engagement, mixed methods research, and Latino health disparities, the team will adapt the videos to attend to the needs of Latinos-both Spanish and English speakers. In Aim 1) the study team will use a four-phase qualitative research process to ensure that IC tools meet the informational, cultural, and linguistic needs of Latinos with advanced GI cancer. In Aims 2 & 3) the resulting Spanish-English suite of IC tools will be tested to determine its effect on Latino patients' and caregivers' decision-making about cancer treatment and EOL care, and their satisfaction with communication processes and cancer care. This will be accomplished through a multicenter randomized trial involving 116 Latinos with advanced GI cancers and their caregivers, recruited from seven academic and community cancer centers serving diverse Latino populations. This intervention is practical, scalable and has immense potential to impact the quality of cancer care provided to Latinos. This project aligns with the U54 Partnership as it aims to reduce cancer disparities by improving communication with Latinos. The project prioritizes involvement of Latino students to foster the next generation of URM researchers and more fully harmonize the research with the needs and perspectives of the broader Latino community. Finally, this project forges and solidifies relationships with Latino communities, and harnesses the complementary expertise of its DF/HCC and UMass Boston investigators, thereby laying the groundwork for a sustainable partnership for cross-cutting cancer disparities research.