Impact of the Therapeutic Alliance on Reduction of Disparities in Latino End-of-Life Cancer Care

项目摘要 该提案旨在开发和试点测试一种有理论基础的行为干预措施，以促进 发展肿瘤学家和拉丁美洲晚期癌症患者之间的治疗联盟。这 干预将以技术援助的理论模型和拉丁美洲技术援助的概念模型为基础 癌症患者，我们将通过拟议的形成性研究开发。数据基于 文献和我们的初步研究，这种干预将寻求通过促进信任， 同理心、共同决策和以病人为中心的沟通。干预框架将是 基于自我决定理论（SDT），该理论认为行为改变（TA的改善） 可能是在满足自主性、能力和相关性的条件时。首先，将采用混合方法 创建肿瘤学家和拉丁美洲癌症患者之间TA的概念模型，以确定目标 干预（图1）。aim1a将利用来自一个正在进行的资助的多地点，前瞻性 观察R01对医学/宗教/文化信仰、TA和EOL护理结局的影响（n> 270）。对于目标1b，我们 将对肿瘤学家（n = 9）和拉丁美洲癌症患者（n = 35）进行深入访谈和焦点小组， 为了获得对TA的更细致的理解，并完善我们的概念模型。一旦介入 创建后，我们将使用利益相关者（目标1b参与者）的反馈来完善干预措施 其可行性和可接受性。对于目标3，将由8名肿瘤学家和50名患者组成的独立研究组， 研究中，一半（n = 4名肿瘤学家，25名患者）将随机接受TA干预培训，另一半（n = 4名肿瘤学家，25名患者）将接受TA干预培训。 一半（n = 4，25）将被随机分配到常规护理。我们将审查可行性（干预完成率）， 可接受性（肿瘤学家和患者的满意度），以及TA干预改善TA的有效性 肿瘤学家和拉丁美洲癌症患者之间的差异，以患者THC评分作为主要结局。 次要结局将包括参与ACP和EOL护理。Tergas博士的长期职业目标是 建立一个领先的，独立的研究计划，重点是减少在EOL护理的差距， 实施和传播有效的，医疗支持的干预措施，用于临床实践。作为 作为她独立研究计划的基础，她的短期职业目标是开发一个可实施的， 循证行为干预改善肿瘤学家和拉丁美洲人之间的治疗联盟 癌症患者。这个K08奖申请代表了她的战略，以实现我的短- 长期目标，包括连贯和互补的研究目标和培训目标。具体到 为了实现她的职业目标，她需要在干预发展和实施科学方面的培训， 以及继续培训和指导EOL护理差异。在我的研究报告中， 研究目标将帮助我实现这一培训和经验，以及为未来提供初步数据 R01级补助金申请。

PROJECT SUMMARY This proposal aims to develop and pilot test a theoretically-grounded, behavioral intervention to promote the development of a therapeutic alliance between oncologists and Latino advanced cancer patients. This intervention will be grounded in the theoretical model of the TA and a conceptual model of the TA in Latino cancer patients that we will develop through the proposed formative research. Based on data from the literature and our preliminary studies, this intervention will seek to improve oncologist TA by promoting trust, empathy, shared decision-making, and patient-centered communication. The intervention framework will be based on Self Determination Theory (SDT), which posits that behaviour change (improvement in TA) is more likely when conditions of autonomy, competence, and relatedness are met. First, mixed methods will be used to create a conceptual model of the TA between oncologists and Latino cancer patients to determine targets for the intervention (Fig 1). Aim1a will leverage data from an ongoing funded multi-site, prospective observational R01 on medical/religious/cultural beliefs, TA, and EOL care outcomes (n>270). For Aim 1b, we will conduct in-depth interviews and focus groups with oncologists (n=9) and Latino cancer patients (n=35) in order to gain a more nuanced understanding of the TA and refine our conceptual model. Once the intervention has been created, we will then refine the intervention using stakeholder (Aim 1b participants) feedback regarding its feasibility and acceptability. For Aim 3, an independent set of 8 oncologists and 50 patients will be studied, half (n=4 oncologists, 25 patients) will be randomized to training in the TA intervention, and the other half (n=4, 25) will be randomized in to usual care. We will examine feasibility (rate of intervention completion), acceptability (oncologists’ and patients’ satisfaction), and efficacy of the TA intervention for improving the TA between oncologists and Latino cancer patients, as measured by patient THC scores as the primary outcome. Secondary outcomes will include engagement in ACP and EOL care. Dr. Tergas’s long-term career goal is to establish a leading, independent program of research focused on the reduction of disparities in EOL care by implementing and disseminating effective, empirically-supported interventions for use in clinical practice. As a foundation for her independent research program, her short-term career goal is to develop an implementable, evidence-based behavioral intervention for improving therapeutic alliance between oncologists and Latino cancer patients. This K08 award application represents the cornerstone of her strategy to achieve my short- term goal and consists of cohesive and complementary research aims and training objectives. Specifically, in order to achieve her career goals, she needs training in intervention development and implementation science, as well as continued training and mentorship in EOL care disparities. Conducting the research detailed in my research aims will help me achieve this training and experience, as well as provide preliminary data for a future R01-level grant application.