Impact of the Therapeutic Alliance on Reduction of Disparities in Latino End-of-Life Cancer Care

治疗联盟对减少拉丁裔临终癌症护理差异的影响

• 批准号: 10463514
• 负责人: Ana Isabel Tergas
• 金额: $ 23.48万
• 依托单位: BECKMAN RESEARCH INSTITUTE/CITY OF HOPE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10463514
• 关键词: Address; Advance Care Planning; Advanced Malignant Neoplasm; Applications Grants; Award; Behavior Therapy; Belief; Cancer Patient; Caring; Cause of Death; Client satisfaction; Collaborations; Communication; Competence; Data; Data Analyses; Development; Emotional; Empathy; Ethnic Origin; Family Caregiver; Feedback; Focus Groups; Foundations; Funding; Future; Goals; Grant; Hospitals; Human; Immigrant; Impairment; Intervention; Interview; Latino; Literature; Malignant Neoplasms; Measures; Medical; Mentorship; Methods; Minority Groups; Modeling; Observational Study; Oncologist; Outcome; Participant; Patients; Perception; Physicians; Provider; Psychotherapy; Quality of life; Randomized; Religion and Spirituality; Reporting; Research; Resuscitation; Self Determination; Services; Site; Terminal Disease; Testing; Theoretical model; Therapeutic; Training; Treatment Effectiveness; Treatment Efficacy; Trust; United States National Institutes of Health; acceptability and feasibility; base; behavior change; cancer care; care outcomes; career; clinical practice; cohesion; disparity reduction; effective intervention; end of life; end of life care; evidence base; expectation; experience; field study; hospice environment; implementation science; improved; patient oriented; preference; primary outcome; prognostic; programs; prospective; secondary outcome; shared decision making; theories; therapy design; therapy development; treatment as usual

PROJECT SUMMARY This proposal aims to develop and pilot test a theoretically-grounded, behavioral intervention to promote the development of a therapeutic alliance between oncologists and Latino advanced cancer patients. This intervention will be grounded in the theoretical model of the TA and a conceptual model of the TA in Latino cancer patients that we will develop through the proposed formative research. Based on data from the literature and our preliminary studies, this intervention will seek to improve oncologist TA by promoting trust, empathy, shared decision-making, and patient-centered communication. The intervention framework will be based on Self Determination Theory (SDT), which posits that behaviour change (improvement in TA) is more likely when conditions of autonomy, competence, and relatedness are met. First, mixed methods will be used to create a conceptual model of the TA between oncologists and Latino cancer patients to determine targets for the intervention (Fig 1). Aim1a will leverage data from an ongoing funded multi-site, prospective observational R01 on medical/religious/cultural beliefs, TA, and EOL care outcomes (n>270). For Aim 1b, we will conduct in-depth interviews and focus groups with oncologists (n=9) and Latino cancer patients (n=35) in order to gain a more nuanced understanding of the TA and refine our conceptual model. Once the intervention has been created, we will then refine the intervention using stakeholder (Aim 1b participants) feedback regarding its feasibility and acceptability. For Aim 3, an independent set of 8 oncologists and 50 patients will be studied, half (n=4 oncologists, 25 patients) will be randomized to training in the TA intervention, and the other half (n=4, 25) will be randomized in to usual care. We will examine feasibility (rate of intervention completion), acceptability (oncologists’ and patients’ satisfaction), and efficacy of the TA intervention for improving the TA between oncologists and Latino cancer patients, as measured by patient THC scores as the primary outcome. Secondary outcomes will include engagement in ACP and EOL care. Dr. Tergas’s long-term career goal is to establish a leading, independent program of research focused on the reduction of disparities in EOL care by implementing and disseminating effective, empirically-supported interventions for use in clinical practice. As a foundation for her independent research program, her short-term career goal is to develop an implementable, evidence-based behavioral intervention for improving therapeutic alliance between oncologists and Latino cancer patients. This K08 award application represents the cornerstone of her strategy to achieve my short- term goal and consists of cohesive and complementary research aims and training objectives. Specifically, in order to achieve her career goals, she needs training in intervention development and implementation science, as well as continued training and mentorship in EOL care disparities. Conducting the research detailed in my research aims will help me achieve this training and experience, as well as provide preliminary data for a future R01-level grant application.

项目摘要 该提案旨在开发和试点测试理论上的行为干预措施，以促进 肿瘤学家和拉丁裔晚期癌症患者之间的治疗联盟发展。这 干预将基于TA的理论模型和拉丁裔TA的概念模型 我们将通过拟议的格式研究发展的癌症患者。基于来自 文学和我们的初步研究，这种干预措施将通过促进信任， 同理心，共同的决策和以患者为中心的沟通。干预框架将是 基于自我确定理论（SDT），认为行为改变（改进）是更多 当满足自治，能力和相关性的条件时。首先，将使用混合方法 在肿瘤学家和拉丁裔癌症患者之间创建一个TA的概念模型以确定目标 用于干预（图1）。 AIM1A将利用正在进行的多站点，潜在的资助的数据 关于医学/宗教/文化信仰，TA和EOL护理结果的观察R01（n> 270）。对于目标1B，我们 将与肿瘤学家（n = 9）和拉丁裔癌症患者（n = 35）进行深入的访谈和焦点小组 为了获得对TA的更细微的理解并完善我们的概念模型。一旦干预 已经创建了，然后我们将使用利益相关者（AIM 1B参与者）反馈来完善干预措施 关于它的可行性和可接受性。对于AIM 3，一组独立的8位肿瘤学家和50名患者将是 研究菌，一半（n = 4个肿瘤学家，25名患者）将被随机分配给TA干预措施，而另一个则将 一半（n = 4，25）将被随机分配给通常的护理。我们将检查可行性（干预完成率）， 可接受性（肿瘤学家和患者的满意度）以及TA干预的效率 在肿瘤学家和拉丁裔癌症患者之间，通过患者THC评分作为主要结果来衡量。 次要结果将包括参与ACP和EOL护理。 Tergas博士的长期职业目标是 建立一个领先的独立研究计划，重点是减少EOL护理中的差异 实施和传播有效的，经验支持的干预措施，用于临床实践。作为 她的独立研究计划的基础，她的短期职业目标是开发可实施的， 基于证据的行为干预措施，以改善肿瘤学家与拉丁裔的治疗联盟 癌症患者。该K08奖项申请代表了她实现我短暂的策略的基石 术语目标以及凝聚力和互补的研究目标和培训目标。具体来说，在 为了实现自己的职业目标，她需要在干预开发和实施科学方面进行培训， 以及EOL护理分布中的持续培训和心态。在我的 研究目的将帮助我获得这种培训和经验，并为未来提供初步数据 R01级授予申请。