Palliative Care for High-Grade Glioma

简要总结 WHO III级和IV级胶质瘤（高级别胶质瘤或HGG）是侵袭性恶性原发性脑肿瘤 这是毁灭性的老年患者和照顾者，由于高症状负担，早期的身体和 认知能力下降，照顾者支持需求，以及由预期寿命引起的生存压力 几个月姑息治疗，由国家质量论坛定义为“以患者和家庭为中心的护理， 通过预测、预防和减轻患者整个生命周期的痛苦来优化生活质量 “疾病”，非常适合满足这些患者的复杂需求。多个肿瘤学会建议 早期（诊断后3个月内）将姑息治疗纳入所有癌症的治疗计划 患者老年人对姑息治疗的需求特别高，部分原因是预后较短， 对标准癌症导向治疗的耐受性降低。一般来说，姑息治疗的需要， 通过初级姑息治疗（由任何一线提供者提供，包括神经科， 肿瘤学家）和/或专业姑息治疗（由提供者或多学科团队提供， 姑息治疗培训和认证）。目前的文献表明，HGG患者并不具有所有 他们的姑息治疗需求通过神经肿瘤学家的初级姑息治疗得到满足，但他们也没有 直到他们积极死亡的专业姑息治疗。没有既定的模式来确保 在整个病程中，他们的姑息治疗需要得到满足。在这篇文章中，我提出了一个概念性的 模型的障碍，全面，及时姑息治疗的患者HGG。我的职业目标是 改善对患有HGG的老年人的姑息治疗。在本建议中，我将：1）使用定性 评估HGG老年人的知识、经验和偏好程度的方法， 他们的照顾者，神经肿瘤学家和姑息医学专家关于姑息治疗领域 以及每个领域的初级和专业姑息治疗的最佳平衡; 2）使用现有的 HGG患者从一个大型卫生服务系统，以衡量在何种程度上，服务或护理 在每个姑息治疗领域的过程中交付，并分析姑息治疗之间的关联 提供和整体HGG卫生保健利用率。这两个项目将与我的事业结合起来 发展计划，我已经确定了一个专家导师和顾问团队，并提出 与定性研究方法和实施科学有关的课程，以及临床轮换 以及对老年医学和老龄化研究核心概念的教学式学习。这会让我走上一条 未来职业发展奖，这是我成为独立调查员的第一步 他们的工作改善了对患有HGG的老年人的护理。

Brief Summary WHO Grade III and IV gliomas (high-grade glioma or HGG) are aggressive, malignant primary brain tumors that are devastating for older adult patients and caregivers due to high symptom burden, early physical and cognitive decline, caregiver support needs, and existential distress stemming from life expectancy on the order of months. Palliative care, defined by the National Quality Forum as “patient and family-centered care that optimizes quality of life by anticipating, preventing, and alleviating suffering across the continuum of a patient's illness”, is well-suited to meet the complex needs of these patients. Multiple oncological societies recommend that palliative care be integrated early (within 3 months of diagnosis) into the treatment plan of all cancer patients. Older adults have particularly high palliative care needs, in part due to shorter prognosis and decreased tolerance for standard cancer-directed therapy. Generally, palliative care needs may be addressed through a combination of primary palliative care (delivered by any front-line provider, including neuro- oncologists) and/or specialty palliative care (delivered by a provider or multidisciplinary team with advanced palliative care training and certification). The current literature suggests that patients with HGG do not have all their palliative care needs met through primary palliative care from neuro-oncologists, yet they also are not referred to specialty palliative care until they are actively dying. There is no established model for ensuring their palliative care needs are met throughout the disease course. In this proposal, I present a conceptual model of the barriers to comprehensive, timely palliative care for patients with HGG. My career goal is to improve the delivery of palliative care for older adults with HGG. In this proposal I will: 1) use qualitative methods to assess the range of knowledge, experience, and strength of preferences of older adults with HGG, their caregivers, neuro-oncologists, and palliative medicine specialists regarding the domains of palliative care and the optimal balance of primary and specialty palliative care for each domain; 2) use an existing cohort of patients with HGG from a large health delivery system to measure the extent to which services or care processes in each palliative care domain are delivered, and to analyze the associations between palliative care delivery and overall HGG health care utilization. These two projects will be combined with my career development plan, for which I have identified a team of expert mentors and advisors and am proposing coursework relating to qualitative research methods and implementation science, as well as clinical rotations and didactic learning about core concepts in geriatrics and aging research. This will set me on a path to obtain a future career development award, which is the first step on my path to becoming an independent investigator whose work improves the care of older adults with HGG.