Behavioral and Psychosocial Effects on Study Outcomes in End-Stage Cancer Treatment (BEST End-Stage Cancer Study)

行为和心理社会对终末期癌症治疗研究结果的影响 (也就是最佳终末期癌症研究) 项目摘要 尽管在对癌症的理解和治疗方面取得了很大进展，但 癌症死亡人数仍在上升，癌症仍是美国第二大死因 州(美国)。不仅死于癌症的人数在增加，而且这些人的质量也在提高 死亡率低得令人担忧。在美国，临终关怀被认为是一种公共健康危机 美国国家医学科学院--这一结论得到了我的团队令人不安的发现的支持。我的 研究表明，终末期癌症患者接受化疗的可能性很大， 令人震惊的是，晚期癌症患者对自己的预后和EoL的危害一无所知 治疗，种族/少数民族群体得到的EoL癌症治疗非常差，而且 严重的精神痛苦和痛苦在很大程度上仍然没有得到遏制。当前杰出的调查员 内审办(OIA)的研究确定了解决这些问题的心理社会因素，并将其作为目标； 结果证明了范式的转变和实践的改变。例如，我们展示了：1) “姑息化疗”不会“姑息”，实际上可能弊大于利--&>强调 肿瘤学家需要认识到“过度治疗”的危害并避免开处方 对他们认为濒临死亡的患者进行化疗；2)肿瘤学家的预后沟通可以 改善患者对预后的理解，并导致更知情、更符合价值的EoL护理，但 它很少发生，而且效果不佳--我们的Oncolo-GIST方法是一种简单、有效的方法 肿瘤学家可以放心地传达患者预后的要点；3) 在解决EoL癌症护理方面的差异--&gt；我们针对黑人的神圣干预 患者的医疗不信任和精神护理需求作为促进提前护理计划的一种方式 (ACP)；4)心理社会苦恼对EoL的影响与结果一样重要 决策-&&gt；我们的社会心理干预以“经验回避”为目标 促进照顾者在非加太项目中的心理社会适应和参与。展望未来，这个内审办将 重点关注：1)肿瘤学家沟通；2)癌症差异；3)心理社会苦恼。这就做 利用数据、理论以及临床和学术资源(同事和合作者) 在当前内审办的主持下制定：改善肿瘤学家提供高质量的EoL 癌症护理；提高他们披露预后的频率和有效性；促进癌症 患者对预后的了解；确保公平地提供EoL癌症护理；并减少 患者和照顾者的心理社会困扰，以提高他们的心理健康和促进他们的 参与机场核心计划。续签内审办将使我能够进行研究，帮助确保 临终癌症患者和他们的照顾者得到尽可能高质量的EoL癌症护理。

Behavioral and Psychosocial Effects on Study Outcomes in End-Stage Cancer Treatment (aka, the BEST End-Stage Cancer Study) Project Summary Despite great strides that have been made in the understanding and treatment of cancer, the number of cancer deaths remains on the rise and cancer remains the 2nd leading cause of death in the United States (US). Not only is the number of people dying of cancer increasing, but the quality of those deaths is alarmingly poor. End-of-life (EoL) care in the US has been deemed a public health crisis by the National Academy of Medicine -- a conclusion bolstered by disturbing findings from my group. My research has shown that end-stage cancer patients receive chemotherapy troublingly close to death, that end-stage cancer patients are shockingly uninformed of their prognosis and the harms of EoL treatments, that racial/ethnic minority groups receive dramatically inferior EoL cancer care, and that severe emotional pain and suffering remain largely unchecked. The current Outstanding Investigator Award (OIA) research has identified and targeted psychosocial factors to address these problems; the results have proved paradigm-shifting and practice-changing. For example, we showed that: 1) “palliative chemotherapy” does not “palliate” and may actually do more harm than good -> highlighting the need for oncologists to recognize the harms of “overtreatment” and refrain from prescribing chemotherapy to patients they deem close to death; 2) oncologist prognostic communication can improve patient prognostic understanding and lead to more informed, value-concordant EoL care, but it occurs infrequently, and ineffectively –> our Oncolo-GIST approach as a simple, effective way oncologists can feel comfortable communicating the gist of a patient’s prognosis; 3) that “one size does not fit all” in addressing disparities in EoL cancer care->our Divine Intervention targeting black patients’ medical mistrust and spiritual care needs as a way to promote advance care planning (ACP); 4) that psychosocial distress is an important influence on, as much as outcome of, EoL decision-making->our EMPOWER psychosocial intervention targeting “experiential avoidance” to promote caregiver psychosocial adjustment and engagement in ACP. Going forward, this OIA will focus on: 1) oncologist communication; 2) cancer disparities; and 3) psychosocial distress. I will leverage data, theories,and the clinical and scholarly resources (colleagues and collaborators) developed under the auspices of the current OIA to: improve oncologist delivery of high quality EoL cancer care; increase the frequency and effectiveness of their prognostic disclosures; promote cancer patients’ prognostic understanding; ensure the equitable delivery of EoL cancer care; and reduce psychosocial distress of patients and caregivers to enhance their mental health and promote their engagement in ACP. Renewal of this OIA will enable me to conduct research helping to ensure that dying cancer patients and their caregivers receive the highest quality of EoL cancer care possible.