Artificial Nutrition in Terminally Ill Cancer Patients

描述（由申请人提供）：Dr. Dy是约翰霍普金斯医学院的助理教授和姑息治疗咨询项目的主治医生。通过这个奖项，Dr. Dy希望在癌症姑息治疗的一个重要问题上开展卫生服务和决策研究：在生命末期适当使用人工营养。她将得到肿瘤学、姑息治疗、老年病学和人工营养以及卫生服务研究方法方面专家的指导和支持。为了补充她的研究，迪博士将学习定性研究、传播学、高级卫生服务研究和生物统计方法等课程。对晚期癌症患者的护理往往涉及艰难的选择。在生命末期使用人工营养等技术往往没有帮助，而且可能对生活质量有害。通过一系列的3个研究项目，这笔赠款将审查干预措施在三个不同层次上对提高技术使用的适当性的潜在贡献。首先，在个体患者层面，我们将探讨晚期癌症患者人工营养的决策过程，以及患者和代理人对这一过程的看法以及如何改进。其次，在医院层面，我们将探讨姑息治疗咨询服务的增长是否影响了地方一级人工营养的使用。最后，在区域层面上，我们将检视安宁疗护服务的成长是否影响人工营养的使用。定性和定量的原始数据收集和利用现有数据源的研究相结合，资深科学家的优秀指导，可用的课程，研究会议和观察经验，以及约翰霍普金斯大学的支持性环境，将为Dy博士提供发展成为肿瘤学姑息治疗决策和健康服务研究独立临床研究员所需的技能。

DESCRIPTION (provided by applicant): Dr. Dy is an Assistant Professor and the primary physician for the paliative care consultation programs for Johns Hopkins Medicine. Through this award, Dr. Dy would like to conduct health services and decision-making research on an important issue in cancer palliative care: the appropriate use of artificial nutrition at the end of life. She will have the mentorship and support of experts in oncology, palliative care, geriatrics and artificial nutrition, and health services research methods. To complement her research, Dr. Dy will take courses in qualitative research, communication, and advanced health services research and biostatistics methods. The care of terminally ill patients with cancer often involves difficult choices. The use of technology such as artificial nutrition at the end of life is often not helpful and may be detrimental to quality of life. Through a series of 3 research projects, this grant will examine the potential contribution of interventions to improve the appropriateness of technologic use at three different levels. First, on the individual patient level, we will explore the decision-making process for artificial nutrition in terminally ill cancer patients, as well as patients' and surrogates' perceptions of the process and how it might be improved. Secondly, on the hospital level, we will explore whether the growth in palliative care consultation services has impacted the use of artificial nutrition at the local level. Finally, on the regional level, we will examine whether the growth of hospice services has impacted the use of artificial nutrition. The combination of qualitative and quantitative primary data collection and research utilizing existing data sources, the excellent mentorship of senior scientists, the available coursework, research conferences, and observation experiences, and the supportive environment at Johns Hopkins University will provide Dr. Dy with the skills she needs to develop into an independent clinical researcher in oncology palliative care decision-making and health services research.