Communicating with Oncology Nurses about Values from the Outset (CONVO): An Innovative Primary Palliative Care Intervention in English and Espanol

项目摘要 每个面对疾病的人对什么是重要的/赋予意义/定义可接受的都有独特的观点 生活质量这种观点-个人的健康相关价值观-提供了患者的基础- 中心护理价值观的表达使个人感到被倾听/被尊重，并分享 医疗决策。因此，在癌症护理中，临床医生和患者在早期讨论价值观是至关重要的， 在早期阶段和/或可治愈疾病的情况下。然而，现有证据表明， 进行干预，以改善这种沟通。提供姑息治疗专家，以帮助沟通 关于/使护理与价值观相一致仍然有限，特别是在门诊环境中。肿瘤学指南和 标准要求“初级”姑息治疗（即，由跨专业肿瘤学团队）作为癌症护理的一部分， 每一个病人从诊断的时候。我们开发了一种创新的干预措施-与 肿瘤科护士关于从一开始的价值观（CONVO）-利用信任关系， 病人和护士将结构化的，护士主导的价值观讨论纳入常规门诊 从一开始就提供肿瘤治疗，无论患者的癌症分期或预后如何。护士 总结患者的值，与患者和肿瘤学家共享此总结，并将其纳入所有患者的EHR中 卫生保健提供者审查，并鼓励患者与家人/其他非正式的讨论这些价值观 照顾者或代理人。在我们专门的癌症中心进行的一项试点研究中，CONVO干预是可行的 患者（主要是非拉丁裔白人）和临床医生可接受。我们现在建议扩大这项工作 在我们的中心外，包括讲西班牙语的拉丁美洲癌症患者，最大和增长最快的少数民族， 美国的一个群体，他们在之前的研究中代表性很差，以改善围绕价值观的沟通 在癌症中。具体目标是：1）翻译/创作（语言加上文化适应）CONVO 对接受门诊肿瘤治疗的讲西班牙语的拉丁美洲癌症患者实施干预 照顾他们的社区。2)评估在以下国家实施的干预措施的可行性和有效性： 英语和西班牙语在不同的组织背景和社区。拉丁美洲适应CONVO将 在形成和适应性迭代阶段使用混合方法。为了评估可行性和有效性，我们 然后，将在两个以社区为基础的社区， 拉丁裔占很大比例的肿瘤诊所。主要有效性结局将是 发生价值观讨论（沟通质量评估，以英语/西班牙语验证）， 患者在干预递送时间点后6周（± 2周窗口期）报告。本研究是 在扩展/评估创新的护士主导的初级姑息治疗干预方面具有重要意义， 包括少数民族在内的数千名患者接受符合其价值观的护理，避免繁琐的治疗 不能满足患者的目标，并减少癌症差异。结果将为未来的大规模RCT提供信息。

PROJECT SUMMARY Each person facing illness has a unique perspective on what is important/gives meaning/defines acceptable quality of life. This perspective - the individual's health-related values – provides the foundation of patient- centered care. Articulation of values allows the individual to feel heard/respected as a person and to share in medical decision-making. Thus, in cancer care, clinician-patient discussion of values early on is essential even in the context of early stage and/or curable disease. However, existing evidence indicates a compelling need for interventions to improve this communication. Availability of palliative care specialists to help communicate about/align care with values remains limited, especially in outpatient settings. Oncology guidelines and standards call for “primary” palliative care (i.e., by interprofessional oncology teams) as part of cancer care for every patient from time of diagnosis. We have developed an innovative intervention - Communicating with Oncology Nurses about Values from the Outset (CONVO) – that leverages trusting relationships between patients and nurses to incorporate structured, nurse-led discussions of values in routine outpatient oncology care from the beginning, regardless of the patient's cancer stage or prognosis. The nurse summarizes the patient's values, shares this summary with patient and oncologist, includes it in the EHR for all health care providers to review, and encourages the patient to discuss these values with family/other informal caregivers or surrogates. In a pilot study at our dedicated cancer center, the CONVO intervention was feasible and acceptable to patients (mostly non-Latino Whites) and clinicians. We now propose to expand this work outside our center to include Spanish-speaking Latino cancer patients, the largest and fastest-growing minority group in the US, who have been poorly represented in prior research to improve communication around values in cancer. Specific Aims are: 1) To translate/transcreate (linguistic plus cultural adaptation) the CONVO intervention for implementation with Spanish-speaking Latino cancer patients receiving outpatient oncologic care in their communities. 2) To evaluate the feasibility and effectiveness of this intervention as implemented in English and Spanish in different organizational contexts and communities. Latino adaptation of CONVO will use mixed methods in formative and adaptive iterative phases. To evaluate feasibility and effectiveness, we will then conduct a pre-post pilot trial of the intervention in English and Spanish at two community-based oncology clinics where Latinos are strongly represented. The primary effectiveness outcome will be the occurrence of discussion of values (Quality of Communication assessment, validated in English/Spanish) as reported by patients at 6 weeks (± 2-week window) after the timepoint for intervention delivery. This research is significant in extending/evaluating an innovative nurse-led, primary palliative care intervention that can help thousands of patients including minorities receive care aligned with their values, avoid burdensome treatments that do not serve patient goals, and reduce cancer disparities. Results will inform a future large-scale RCT.