A Novel Approach to Elucidate Mechanisms for Disparity in Cancer Pain Outcomes

描述（由申请人提供）：标题：阐明癌症疼痛结局差异机制的新方法本研究响应广泛的挑战领域（04）临床研究和特定的挑战主题，04- NR-102* 加强姑息治疗和临终研究的方法。 越来越多的文献报道了姑息治疗结局中的种族/民族差异，包括临终关怀登记的不平等，对临终高科技护理的不同偏好，以及症状管理结局的差异。基于选择的联合分析（CBC）是一种基于随机效用理论和数学心理学的有前途的评估技术，可以理解人们的价值，以及当面临竞争性选择时，是什么真正驱使他们选择一组替代品。虽然该技术在市场营销竞技场和消费者研究中得到了很好的应用，但CBC在医疗保健领域的应用相对较新，尽管人们对这种方法的兴趣越来越大。CBC可以增强我们对姑息治疗结果中种族/民族差异的机制的理解。CBC在研究差异来源方面的这一潜在重要应用尚未在姑息治疗研究中得到利用。以癌症疼痛治疗差异为例，我们建议调查CBC在确定癌症疼痛治疗结果种族差异的机制中的实用性和预测有效性。越来越多的证据表明，尽管进行了风险调整，非洲裔美国人接受指南推荐的镇痛治疗的可能性较小，即使在与非少数民族个体水平相似的保险人群中也是如此。系统和提供者层面的因素未能充分阐明造成这些差异的机制。患者层面的因素，包括患者对疼痛治疗的态度和偏好，也可能解释临床差异可能持有答案。使用CBC，这项前瞻性研究提供了一个独特的概念，方法和分析透镜，以了解患者在止痛治疗癌症疼痛的价值，并将此独特的信息与一套全面的社会人口统计学，疾病和疼痛相关的变量。一项措施的预测能力是其有效性的一个关键决定因素;拟议的研究还评估CBC的预测有效性，通过调查声明的偏好（CBC效用）和实际遵守处方止痛癌痛之间的关系。此外，该研究还仔细分析了种族差异，旨在进一步了解癌症疼痛结果的临床差异。本研究中确定的科学方法将为开发以患者为中心的干预措施奠定基础，这些干预措施将患者的偏好纳入复杂的医疗决策中，以改善癌症疼痛的结局，并通过其他症状管理环境的扩展结局。在宾夕法尼亚大学，我们有能力迅速扩大我们的研究能力和员工基础，使科学和整体经济受益。根据美国复苏和再投资法案，目前的项目将创造7个新的就业机会（1个全职，4个兼职和2个每日）。医疗保健通常涉及在风险和不确定性下做出竞争性选择。这项研究使用了一种新的技术，基于选择的联合分析（CBC），以了解患有癌症疼痛的非洲裔美国人和白人在做出疼痛治疗决定时是否使用不同的心理权衡;对癌症疼痛治疗有不同的偏好;以及这可能与他们对癌症疼痛止痛药的依从性有关。CBC方法对于生成关于患者亚组如何做出关于选择的决策的知识具有意义，这些选择包括症状管理、高级护理计划、临终关怀登记或使用技术先进的临终关怀。研究结果将有助于确定敏感的目标量身定制，以病人为中心的干预措施，以提高姑息治疗结果的公平性。

DESCRIPTION (provided by applicant): Title: A Novel Approach to Elucidate Mechanisms for Disparity in Cancer Pain Outcomes This study responds to the broad challenge area (04) Clinical Research, and the specific challenge topic, 04- NR-102* Methods to Enhance Palliative Care and End-of-Life Research. Racial/ethnic disparities in palliative care outcomes are increasingly reported in the literature including inequalities in hospice enrollment, differential preference for high technology care at the end-of-life, and disparities in symptom management outcomes. Choice-Based Conjoint Analysis (CBC) is promising valuation technique grounded in the Random Utility Theory and mathematical psychology to understand what people value and what really drives them to choose one set of alternatives over another when faced with competing choices. While the technique is well established in the marketing arena and consumer research, the application of CBC in the healthcare field is relatively new, although there is growing interest in this methodology. CBC may enhance our understanding of the mechanisms underlying racial/ethnic disparities in palliative care outcomes. This potentially important application of CBC in studying sources of disparities has not been exploited in palliative care research. Using cancer pain treatment disparities as an exemplar, we propose to investigate the utility and predictive validity of CBC in identifying mechanisms underlying racial disparities in cancer pain treatment outcomes. Accumulating evidence suggests that African Americans are less likely to receive guideline recommended analgesia despite risk-adjustment and even among those insured at similar levels as non-minority individuals. The system and provider-level factors have not been able to fully explicate the mechanisms contributing to these disparities. Patient-level factors, including patients' attitudes and preferences towards pain treatment, that may also account for clinical disparities may hold the answer. Using CBC, this prospective study offers a unique conceptual, methodological, and analytical lens to understanding what value patients place in analgesic treatment for cancer pain and link this unique information to a comprehensive set of socio-demographic, illness and pain-related variables. Predictive ability of a measure is a critical determinant of its validity; the proposed study also assesses the predictive validity of CBC by investigating the relationship between stated preference (CBC utilities) and actual adherence to prescription analgesia for cancer pain. Moreover, the research carefully incorporates an analysis of racial disparities across aims to further understanding of clinical differences in cancer pain outcomes. The scientific approach identified in this study will lay the foundation for developing patient-centered interventions that incorporate patient preferences into complex medical decision-making in improving cancer pain outcomes and by extension outcomes in other symptom management settings. At University of Pennsylvania, we are well-positioned to quickly expand our research capacity and employee- base benefitting the science and the overall economy. In keeping with the American Recovery and Reinvestment Act, the current project will create 7 new jobs (1 full-time, 4 part-time, and 2 per-diem). Healthcare often involves making competing choices under risks and uncertainties. This research uses a novel technique, Choice-based Conjoint Analysis (CBC), to understand if African Americans and Whites with cancer pain use different mental trade-offs in arriving at pain treatment decisions; have differential preferences for cancer pain treatment; and how this may relate to their adherence to pain medications for cancer pain. CBC method has implications for generating knowledge about how subgroups of patients make decisions regarding choices such as symptom management, advanced care planning, hospice enrollment, or the use of technologically advanced end-of-life care. Findings will help identify targets sensitive to tailored, patient-centered interventions in improving equity in palliative care outcomes.