Pediatric Cancer Interdisciplinary Team Training for Regoaling CARE Discussions

小儿癌症跨学科团队培训以调整 CARE 讨论

• 批准号: 8957303
• 负责人: John Chris Feudtner
• 金额: $ 21.92万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8957303
• 关键词: Address; Advanced Malignant Neoplasm; Awareness; Bone Marrow Transplantation; Brain Neoplasms; Cancer Relapse; Caring; Clinic Visits; Clinical; Cognitive; Complement; Complication; Consultations; Counseling; Decision Making; Development; Diagnosis; Diagnostic; Disease; Educational Intervention; Elements; Emotional; Emotions; Enrollment; Ethnography; Family; Feeling; Future; Individual; Inpatients; Intervention; Interview; Learning; Life; Malignant Childhood Neoplasm; Malignant Neoplasms; Medical; Modeling; Nurse Practitioners; Organizational Change; Outcome; Palliative Care; Parents; Patient Care; Patients; Pediatric Oncologist; Pediatric Oncology; Perception; Phase I Clinical Trials; Process; Psychologist; Publishing; Quality of life; Relapse; Research; Sampling; Social Workers; Solid Neoplasm; Specific qualifier value; Structure; Symptoms; Testing; Time; Training; Uncertainty; Work; base; cancer therapy; cohort; ethnographic method; experience; improved; instrument; meetings; member; oncology; outcome forecast; pediatric patients; post intervention; public health relevance; standardize measure

 DESCRIPTION (provided by applicant): How can we improve the care of patients with intractably advancing terminal cancer, compassionately and effectively transitioning them from disease-directed therapy to palliative care? We propose to study the ways in which interdisciplinary pediatric oncology teams "regoal," shifting from providing treatment with a curative intent to acknowledging that cure cannot be attained and instead counseling patients and parents to pursue treatments that aim to minimize symptoms and maximize quality of life during the remaining lifetime of the patient. We do so guided by the premise (based in part on published research findings as well as our extensive clinical experience) that this regoaling process often does not occur in a coordinated manner for every member within these interdisciplinary teams, resulting in the delivery of mixed messages to pediatric patients and their parents (or guardians), which in turn inhibits the process of regoaling for the patients and parents. We will perform this study using a mixture of quantitative and ethnographic methods, and will do so within the framework of training several interdisciplinary teams to engage in structured conversations that will facilitate regoaling when new adverse diagnostic or complication information regarding patients arises, information that may be available at the time of diagnosis (such as the diagnosis of a uniformly fatal brain tumor), at the time of a cancer relapse or the development of a major complication, or when contemplating enrollment into a phase 1 trial. Regoaling, as we have found in our studies of parental decision-making regarding pediatric patients with cancer and other life-threatening illnesses, is a cognitive, emotional, and relational process. The theoretical framework we have developed regarding regoaling provides a conceptual model for how to structure conversations to facilitate reassessment and regoaling. In this proposal, we are applying the regoaling framework not to parents (or patients) but rather to the changes that need to occur within interdisciplinary team members, and their interactions with each other, to facilitate the team's process of regoaling. Our focus on oncology team regoaling complements two other approaches that facilitate the use of palliative care by patients with advanced cancer, namely training clinicians to have conversations with patients, and embedding palliative care consultations into the care processes.

 描述（由申请人提供）：我们如何改善晚期癌症患者的护理，同情和有效地将他们从疾病导向治疗过渡到姑息治疗？我们建议研究跨学科儿科肿瘤学团队“重新定位”的方式，从提供治疗的治疗目的转变为承认无法治愈，而是咨询患者和父母寻求旨在最大限度地减少症状和最大限度地提高生活质量的治疗。我们这样做的前提（部分基于已发表的研究结果以及我们广泛的临床经验）是，这种重新设定目标的过程通常不会以协调的方式发生在这些跨学科团队的每个成员中，导致向儿科患者及其父母（或监护人）传递混合信息，这反过来又抑制了患者和父母的重新设定目标的过程。我们将使用定量和人种学方法进行这项研究，并将在培训多个跨学科团队的框架内进行，以便在出现新的不良诊断或患者并发症信息时进行结构化对话，这些信息可能在诊断时可用在癌症复发或发生重大并发症时，或在考虑入组I期试验时，可以使用这些数据（如诊断为一致致命的脑肿瘤）。正如我们在对患有癌症和其他危及生命的疾病的儿科患者的父母决策的研究中所发现的那样，重新设定目标是一种认知、情感和心理上的影响。 关系过程。我们所发展的关于重新目标化的理论框架为如何组织对话以促进重新评估和重新目标化提供了一个概念模型。在这个提议中，我们不是将重新设定目标的框架应用于父母（或患者），而是应用于跨学科团队成员内部需要发生的变化，以及他们之间的相互作用，以促进团队的重新设定目标的过程。我们对肿瘤团队目标的关注补充了另外两种促进晚期癌症患者使用姑息治疗的方法，即培训临床医生与患者进行对话，并将姑息治疗咨询嵌入护理过程。