Communicating the Gist of Prognosis: An intervention to improve prognostic understanding in advanced lymphoma

传达预后要点：提高对晚期淋巴瘤预后了解的干预措施

• 批准号: 10526566
• 负责人: Kelly McConnell
• 金额: $ 27.44万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-25 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10526566
• 关键词: Address; Advance Care Planning; Advance Directives; Advanced Malignant Neoplasm; Agreement; Black race; Cancer Center; Cancer Patient; Caring; Cessation of life; Clinical Research; Communication; Decision Making; Development; Diagnosis; Disease; Disease Progression; Do Not Resuscitate Order; Enrollment; Focus Groups; Foundations; Goals; Health Personnel; Healthcare; Hearing; Hematologic Neoplasms; Hematologist; Hematology; Hospice Care; Intensive Care; Intervention; Learning; Liquid substance; Lymphoma; Malignant Neoplasms; Medical; National Institute on Minority Health and Health Disparities; Oncologist; Outcome; Palliative Care; Participant; Patients; Pre-Post Tests; Prognosis; Public Health; Quality of life; Race; Randomized Controlled Trials; Refractory Disease; Relapse; Research; Risk; Solid; Solid Neoplasm; Surgeon; Survival Rate; Techniques; Testing; Training; Treatment Efficacy; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; acceptability and feasibility; base; black patient; black/white disparity; care preference; clinical care; college; end of life; end of life care; health goals; health literacy; hospice environment; hospital admission rate; improved; information processing; innovation; intervention effect; novel strategies; patient engagement; pilot test; post intervention; preference; primary outcome; prognostic; racial disparity; racial health disparity; satisfaction; secondary outcome; standard care; theories; therapy design; tumor

PROJECT SUMMARY Prognostic understanding is vital to advanced cancer patients’ ability to receive end-of-life (EOL) care consistent with their preferences. Advanced cancer patients who have an accurate prognostic understanding are more likely to engage in advance care planning (ACP; e.g. do-not-resuscitate order), prefer comfort care over intensive care, receive care consistent with their preferences, and die in their preferred place of death. Research on prognostic understanding has largely focused on white patients with advanced solid tumors. This gap is notable due to the unique disease trajectory of advanced lymphoma. While the initial treatment goal is cure, prognosis suddenly and dramatically worsens following disease progression with the majority of patients nearing death. Less than half of patients with a hematologic malignancy have an accurate understanding of their prognosis or engage in ACP and hematologic malignancy patients are more likely to receive intensive EOL care than solid tumor patients. Further, black patients have higher rates of poor prognostic understanding and burdensome intensive EOL care and are less likely to engage in ACP than white patients. The low rates of ACP and high rates of intensive EOL care in patients with hematologic malignancies, especially black patients, point to a need for interventions to improve prognostic understanding and reduce racial disparities in ACP. The purpose of this project is to refine and pilot test a communication intervention to improve black and white advanced lymphoma patient prognostic understanding and engagement in ACP. The goals of this study are to: (1) develop a culturally appropriate communication intervention to improve hematologists’ ability to clearly communicate to black and white patients about prognosis; (2) evaluate the feasibility and acceptability of the intervention among hematologists and black and white advanced lymphoma patients; and (3) test the pre-post effect of the intervention on black and white patient prognostic understanding (primary outcome), engagement in ACP, completion of advance directives, quality of life, patient and hematologist communication satisfaction, and patient-hematologist agreement on the patient’s healthcare values (secondary outcomes). To meet these goals, we will conduct focus groups with hematologists (n=16) and black and white advanced lymphoma patients (n=32) to improve the intervention. Next, we will pilot test the intervention with n=8 hematologists and n=40 patients and assess outcomes at baseline, post-intervention, and three months later to examine the feasibility, acceptability, and pre-post effect of the intervention. These results will inform a NIH R01 application to conduct a large-scale randomized controlled trial of intervention efficacy. Grounded in the established Fuzzy Trace Theory, the present study takes the novel approach of targeting information processing strategies used during decision making. This project will form a strong foundation for research on this brief scalable intervention with strong potential to improve prognostic understanding, ACP, and values-concordant EOL care.

项目摘要 预后理解对于晚期癌症患者接受生命终止（EOL）护理的能力至关重要 与他们的偏好一致。具有准确预后的高级癌症患者 更有可能参与预先护理计划（ACP；例如，不静止的命令），更喜欢舒适护理 过度护理，接受符合其偏好一致的护理，并在他们偏爱的死亡场所死亡。 对预后理解的研究主要集中在患有晚期实体瘤的白人患者上。这 由于晚期淋巴瘤的独特疾病轨迹，缺口值得注意。而最初的治疗目标是 大多数患者的疾病进展后，治愈，进展突然和急剧恶化 接近死亡。血液系统恶性肿瘤的患者中，只有一半的患者对 他们的预后或参与ACP和血液系统恶性肿瘤患者更有可能接受密集 EOL护理比实体肿瘤患者。此外，黑人患者的预后不良率较高 和燃烧的EOL护理，与白人患者相比，参与ACP的可能性较小。低率 血液学恶性肿瘤的患者，尤其是黑人患者，ACP和高强度EOL护理率 指出需要采取干预措施来改善预后理解并减少ACP中的种族分布。这 该项目的目的是完善和试点测试沟通干预以改善黑白 晚期淋巴瘤患者的预后理解和ACP的参与度。这项研究的目标是： （1）开发一种适当的文化沟通干预措施，以提高血液学家的清晰能力 与黑白患者有关提示进行沟通； （2）评估 血液学家和黑白晚期淋巴瘤患者之间的干预； （3）测试前孔 干预对黑白患者预后理解的影响（主要结果），参与度 在ACP中，提前指令，生活质量，患者和血液学家沟通满意度的完成， 患者的医疗保健价值观（次要结果）和患者流动学家一致。满足这些 目标，我们将与血液学家（n = 16）和黑白晚期淋巴瘤进行焦点小组 患者（n = 32）改善干预措施。接下来，我们将试用N = 8血液学家和 n = 40名患者和基线，干预后的评估结果，三个月后检查 干预的可行性，可接受性和前效应。这些结果将告知NIH R01申请 进行干预效率的大规模随机对照试验。扎根于已建立的模糊 痕量理论，本研究采用了针对使用信息处理策略的新方法 在决策过程中。该项目将构成研究此简短可扩展的研究 具有强大潜力的干预措施，以提高预后理解，ACP和价值观的EOL护理。