Artificial Nutrition in Terminally Ill Cancer Patients

描述(由申请人提供)：Dy博士是约翰·霍普金斯医学院姑息治疗咨询项目的助理教授和主任医师。通过这个奖项，Dy博士希望就癌症姑息治疗中的一个重要问题--生命末期适当使用人工营养--进行健康服务和决策研究。她将得到肿瘤学、姑息治疗、老年医学和人工营养以及卫生服务研究方法方面的专家的指导和支持。为了补充她的研究，Dy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学方法等课程。癌症绝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无济于事，可能会损害生活质量。通过一系列3个研究项目，这笔赠款将审查干预措施在三个不同层面上改善技术使用的适当性的潜在贡献。首先，在患者个人层面，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和如何改进。第二，在医院层面，我们会探讨姑息治疗咨询服务的增长有否影响本地使用人造营养的情况。最后，在区域层面上，我们将研究临终关怀服务的增长是否影响了人工营养的使用。结合利用现有数据源的定性和定量初级数据收集和研究、资深科学家的出色指导、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博士提供她所需的技能，使她能够发展成为肿瘤学姑息治疗决策和卫生服务研究的独立临床研究员。

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.