Impact of Specialist Palliative Care on Outcomes in Advanced Stage Lung Cancer

 描述(由申请人提供)：本提案将确定专家姑息治疗对晚期肺癌患者以患者为中心的结果和癌症治疗质量的影响。此外，还将探讨在临床实践中整合的障碍和促进者。专科姑息治疗减轻了患者的症状负担，提高了生活质量，但在临床实践中未得到充分利用。国家癌症政策委员会已经 将低质量的癌症护理定义为“已知有效的做法未得到充分利用”。目前姑息治疗研究中的重要知识空白导致了这种利用不足。中心假设是，早期、综合的专家姑息治疗改善了晚期肺癌患者的预后和癌症治疗的质量。在一种混合方法的方法中，将确定姑息治疗转介和医疗保健利用与患者死亡率之间的关联。将首次确定姑息治疗过程中的差异及其与护理质量差异的关联。 提供者对与常规肺癌护理整合的障碍和促进者的看法将 被探索。所有这些研究都将在国家退伍军人事务部医疗系统中进行，利用强大的癌症登记和全面的患者护理数据库。这项提案的结果将为开发一种有效的姑息治疗模式提供信息，以便在医疗保健系统中实施。这一模式预计将适用于集成的医疗保健系统，并最终可能在其他晚期癌症患者群体中进行测试。这项拟议的研究的基本原理是，它有可能减少这些因素 这降低了姑息治疗的接受度，并对肺癌的治疗模式产生了重大影响。这项建议具有确定干预措施的巨大潜力，这些干预措施可以改善护理提供，增强临终体验，并促进更多地利用姑息治疗 在临床实践中。这项建议与国家癌症研究所的使命有关，即支持与癌症治疗和对患者及其家人的持续护理有关的研究。这项研究是首席研究员K07职业发展计划的一个组成部分，该计划展示了朝着研究独立的合乎逻辑的科学进展，最终目标是在获奖期结束前获得R级资金。这项提案包括了科学技能发展的详细计划和作为混合方法研究人员获得熟练程度的计划。俄勒冈健康与科学大学和波特兰退伍军人事务医疗中心的支持性研究环境为这一建议的可行性提供了证据。研究进展和职业发展将由一组精选的高级调查人员监督，并得到卫生服务研究与发展中心和俄勒冈州临床和翻译研究所早期职业调查学者计划的支持。

 DESCRIPTION (provided by applicant): This proposal will determine the impact of specialist palliative care on patient-centered outcomes and the quality of cancer care among advanced stage lung cancer patients. In addition, barriers and facilitators to integration in clinical practce will be explored. Specialist palliative care decreases patients' symptom burden and improves quality of life, but it is underutilized in clinical practice. The National Cancer Policy Board has defined poor-quality cancer care as when "practices of known effectiveness are being underutilized". Important knowledge gaps in current palliative care research contribute to this underutilization. The central hypothesis is that early, integrated specialist palliative care improves outcomes and the quality of cancer care among advanced stage lung cancer patients. In a mixed-methods approach, the association between palliative care referral and healthcare utilization and patient mortality will be determined. For the first time, variations in the processs of palliative care and their association with variations in the quality of care will be determined. Providers' perceptions of barriers and facilitators to integration with usual lung cancer care will be explored. All of these studies will be conducted in the national Veterans Affairs healthcare system utilizing a robust cancer registry and comprehensive patient care databases. The results from this proposal will inform the development of an effective palliative care model for implementation in healthcare systems. This model is expected to be applicable to integrated healthcare systems and may eventually be tested in other advanced cancer patient populations. The rationale that underlies the proposed research is that it has the potential to diminish factors that have decreased uptake of palliative care and substantially impact the lung cancer treatment paradigm. This proposal has significant potential to identify interventions that could improve care delivery, enhance end- of-life experiences, and promote greater utilization of palliative care in clinical practice. This proposal is relevant to the mission of the National Cancer Institute to support research concerned with the treatment of cancer and the continuing care of patients and their families. This research is one component of the principal investigator's K07 career development plan that demonstrates a logical scientific progression towards research independence with the ultimate goal of obtaining R-level funding by the end of the award period. A detailed plan for scientific skill development and obtaining proficiency as a mixed-methods researcher are included in this proposal. Lending evidence to the feasibility of this proposal is the supportive research environments at Oregon Health and Science University and the Portland Veterans Affairs Medical Center. Research progress and career development will be overseen by a select group of senior investigators, and supported by the Health Services Research & Development center and the Oregon Clinical and Translational Research Institute Scholar's Program for early career investigators.