An Inter-Personal Framework for Lung Cancer Decision-Making in African Americans

非裔美国人肺癌决策的人际框架

• 批准号: 8433539
• 负责人: Simon J. Craddock Lee
• 金额: $ 7.47万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8433539
• 关键词: Accounting; Address; Affect; African American; Aftercare; Age; Anxiety; Attention; Attitude; Behavioral; Belief; Benefits and Risks; Cancer Etiology; Cancer Patient; Caring; Cessation of life; Characteristics; Clinic; Clinical; Clinical Trials; Cognition; Cognitive; Communication; Communities; Comorbidity; Complement; Consolidation Therapy; Data; Decision Making; Diagnosis; Diagnostic; Dimensions; Disease; Emotions; Ethnography; Family; Family dynamics; Friends; Goals; Heterogeneity; Histology; Home environment; Intervention; Interview; Joints; Knowledge; Lead; Maintenance Therapy; Malignant neoplasm of lung; Marital Status; Medical; Methods; Minority; Morbidity - disease rate; Non-Small-Cell Lung Carcinoma; Oncologist; Outcome; Patients; Physicians; Population; Process; Public Health; Quality of life; Recommendation; Reporting; Research; Resources; Science; Series; Shapes; Smoking Status; Social support; Spouses; Staging; Surveys; Survival Rate; Text; Therapeutic; Time; Treatment outcome; Uncertainty; Underrepresented Minority; Visit; Weighing patient; Woman; Work; advanced disease; cancer care; cancer therapy; clinical care; coping; evidence base; falls; improved; loved ones; men; mortality; outcome forecast; psychosocial; shared decision making; social; theories; trend

DESCRIPTION (provided by applicant): The social dimension of patient decision-making is relatively understudied, although oncologists routinely recommend that patients bring a spouse or close friend to a medical visit. As African American patients talk about their options with thei loved ones, we need to understand how these social relationships effect patient attitudes and beliefs about chronicity, mortality, care, and cure to shape the decisions patients make, including whether to participate in clinical trials. The goal of this study is to develop an inter-personal framework to clarify how social relationships influence the way African American patients make decisions about lung cancer care. Lung cancer is the leading cause of cancer death in the US; overall mortality rates are estimated at 72% for men and 41% for women. Outcomes are worse for African American patients who are generally diagnosed at younger ages, with more advanced disease, and greater comorbidities. Non-small cell lung cancer, in particular, is often diagnosed at advanced stages resulting in poor prognosis. Differences in how the disease itself manifests produce several treatment options even in the context of low overall survival rates. As African American patients weigh such treatment options with their significant others, we need to understand how these conversations affect patient attitudes and beliefs to shape patient decisions, including whether to participate in clinical trials. Though several different behavioral constructs explore dimensions of social support and social influence, they fall short of adequately describing the actual dynamic between patients and their significant others when they talk about making decisions outside of the doctor's office. This study will evaluate the applicability of these different constructs to inter-personal decision-making, and then use anthropological methods to explore the patient-family dynamic to elucidate an inter-personal decision-making framework in lung cancer care. Specific study objectives are to: 1) Develop a preliminary framework of inter-personal decision-making that incorporates applicable behavioral constructs (e.g. perceived versus enacted social support, social influence, dyadic coping,) to delineate the moment-to-moment interactions between patient and significant other; 2) Survey African American lung cancer patients d 18 months of diagnosis (n=100) using the framework constructs; 3) Refine the framework using qualitative data from joint interviews with a subsample of 20 patients and their spouses over three time points (post-diagnosis, treatment, after-care; n= 60 interviews) conducted at home or in community. This research is significant because it combines behavioral theory with patient-reported experiential data to investigate an important dimension of medical decision-making. Findings will lead to evidence-based psycho- social interventions to reduce treatment outcome disparities in African American lung cancer.

描述（由申请人提供）：尽管肿瘤学家通常建议患者将配偶或亲密的朋友带到医疗探访中，但患者决策的社会维度相对研究。当非裔美国人患者与亲人谈论他们的选择时，我们需要了解这些社会关系如何影响患者对慢性，死亡率，护理和治疗方法以塑造患者做出的决策的态度和信念，包括是否参加临床试验。这项研究的目的是开发一个人际关系框架，以阐明社会关系如何影响非裔美国人患者对肺癌护理的决定。肺癌是美国癌症死亡的主要原因。估计男性的总死亡率为72％，女性为41％。对于通常被诊断出年龄较小，患有更晚期疾病和更大合并症的非裔美国人患者而言，结果会更糟。特别是在晚期阶段诊断出非小细胞肺癌，导致预后不良。即使在总体生存率较低的情况下，疾病本身如何表现出几种治疗方案的差异。随着非裔美国人患者与其他重要的治疗选择权衡此类治疗选择，我们需要了解这些对话如何影响患者的态度和信念以塑造患者的决定，包括是否参加临床试验。尽管几种不同的行为构造探索了社会支持和社会影响力的方面，但在谈论在医生办公室外做出决定时，他们还没有充分描述患者与其他重要其他人之间的实际动态。这项研究将评估这些不同构造对个人互决策的适用性，然后使用人类学方法探索患者家庭动态，以阐明肺癌护理中的人际决策框架。特定的研究目标是：1）建立一个人际决策的初步框架，该框架结合了适用的行为结构（例如，感知到的社会支持与颁布的社会支持，社会影响力，二元应对），以描述患者之间的时刻互动和其他重大； 2）调查非裔美国人肺癌患者D使用框架结构进行18个月的诊断（n = 100）； 3）使用在三个时间点（诊断后，治疗后，护理后； n = 60次访谈）的共同访谈中的定性数据来完善框架。这项研究很重要，因为它将行为理论与患者报告的经验数据结合在一起，以研究医疗决策的重要方面。调查结果将导致基于证据的心理干预措施，以减少非裔美国人肺癌的治疗结果差异。