Leveraging behavioral science to improve patient understanding of advanced cancer

项目摘要 大多数晚期癌症患者对其预后和治疗没有准确的了解， 干扰了以患者为中心的高质量医疗保健。获得这些信息通常需要患者 面对紧张的临床讨论，同时理解复杂的医学信息。现有干预措施 提高认识，主要是针对信息的传递，而不评估和减少心理 准确了解预后信息的障碍。这个独立之路奖将装备博士。 石楠德里与必要的技能，以启动她的独立研究生涯，在其中，她的目标是 确定并减少癌症患者在知情医疗决策方面与压力相关的障碍。 候选人之前的工作表明，焦虑可能会降低患者对最近讨论的扫描的准确性 结果（用于监测疾病进展并告知治疗）。在这个职业发展奖，PI 将：（1）巩固压力管理干预的目标和方法，以提高患者的理解 预后信息（即，扫描结果），然后（2）调整，修改，（3）试点测试压力管理 计划，以减少焦虑之前，关键的预后讨论。在威尔康奈尔医学中心 对于临终关怀研究，PI将接受专家指导并完成以下方面的专业培训 晚期癌症和临终关怀，干预适应和临床试验，先进的心理生理学 统计学和领导力。在K99阶段，PI将进行观察性研究，以确认初步数据 将心理因素与患者的理解联系起来，并研究迷走神经张力（通过心率测量 变异性）作为该模式的潜在生理机制。在预约讨论扫描之前 结果在一线治疗期间，75例晚期胃肠道癌或肺癌患者将完成 评估静息心率和自我报告的焦虑、担忧和预期压力。后 预约时，患者将报告他们对这些扫描结果的理解。将比较患者的回答 临床访问的音频记录以确保准确性。分析将测试准确性，心理 因素和心率变异性。定性访谈将引出患者对干预的偏好 调整和交付方法。在R 00阶段，PI将使用此信息调整现有压力 管理计划（公共资源），以减轻焦虑（和/或其他目标）之前，这些任命。 最后，干预的可行性，可接受性和潜在的疗效将在一个试点随机测试。 与常规护理相比，总体而言，该项目将开始解决关键的心理和生理问题， 先前试图改善晚期癌症患者对预后的理解中缺失的因素 信息.鉴于她之前在健康心理学方面的培训和研究，强大的导师团队，并建议 根据培训计划，德里博士有能力成为该领域的独立研究者， 目标是提高晚期癌症患者的生活质量和护理质量。

PROJECT SUMMARY Most advanced cancer patients do not have an accurate understanding of their prognosis and treatment, which interferes with patient-centered, high-quality healthcare. Gaining such information often requires patients to confront stressful clinical discussions while understanding complex medical information. Existing interventions to improve understanding largely target information delivery, without assessing and reducing psychological barriers to hearing prognostic information accurately. This Pathway to Independence Award will equip Dr. Heather Derry with the necessary skills to launch her independent research career, in which she aims to identify and reduce stress-related barriers to informed medical decision-making among patients with cancer. The candidate's prior work suggests that anxiety may reduce patients' accuracy for recently-discussed scan results (used to monitor disease progression and inform treatment). In this career development award, the PI will: (1) solidify targets and methods for a stress management intervention to improve patients' understanding of prognostic information (i.e., scan results), then (2) adapt, revise, and (3) pilot test a stress management program to reduce anxiety prior to key prognostic discussions. At Weill Cornell Medicine's distinguished Center for Research on End-of-Life Care, the PI will receive expert mentorship and complete specialized training in advanced cancer and end-of-life care, intervention adaptation and clinical trials, advanced psychophysiology and statistics, and leadership. In the K99 phase, the PI will conduct an observational study to confirm pilot data linking psychological factors to patient understanding, and investigate vagal tone (measured by heart rate variability) as an underlying physiological mechanism for this pattern. Before an appointment to discuss scan results during first-line treatment, 75 patients with advanced gastrointestinal or lung cancer will complete assessments of resting heart rate and self-reported anxiety, worry, and anticipatory stress. After the appointment, patients will report their understanding of those scan results. Patients' answers will be compared to audio-recorded clinical visits for accuracy. Analyses will test relationships between accuracy, psychological factors, and heart rate variability. Qualitative interviews will elicit patients' preferences for intervention adaptations and delivery methods. In the R00 phase, the PI will use this information to adapt an existing stress management program (a public resource) to mitigate anxiety (and/or other targets) prior to these appointments. Finally, the intervention's feasibility, acceptability, and potential efficacy will be tested in a pilot randomized trial, compared with usual care. Overall, the project will begin to address key psychological and physiological factors missing from prior attempts to improve advanced cancer patients' understanding of prognostic information. Given her prior training and research in health psychology, strong mentorship team, and proposed training plan, Dr. Derry is well-positioned to become an independent investigator in this area, with the overall goal of increasing quality of life and quality of care for people with advanced cancer.