End-of-life treatment preferences of Latino Medicare beneficiaries with cancer

患有癌症的拉丁裔医疗保险受益人的临终治疗偏好

• 批准号: 8218673
• 负责人: ISABEL TORRES
• 金额: $ 11.1万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8218673
• 关键词: End; life; treatment; preferences; Latino

DESCRIPTION (provided by applicant): End of Life Treatment Preferences of Latino Medicare Beneficiaries with Cancer Principal Investigator: Isabel Torres, Dr.P.H. The overall goal of the NCI K01 career development plan is to provide the candidate with a program of mentored research activity and study in the areas of palliative cancer care, health disparities and outcomes research to launch an independent research career with specialization in the integration of these research areas. The five-year plan is carefully designed to 1) obtain further research experience in the areas of palliative cancer care, health disparities and health services research; 2) advance skills related to the design and analyses of prospective palliative care studies through training in advanced statistical methods; 3) improve skills needed to develop and test new instruments and performance measures to improve the accuracy of assessing quality outcomes for both English and Spanish speaking Latinos with cancer; 4) acquire further grant writing skills and experiences, resulting in the submission of an R01 grant before the end of the support period. Properly identifying the end-of-life preferences of cancer patients is a national healthcare priority and understanding the clinical, cultural, psychosocial and system-level factors that influence these decisions is paramount for clinicians and policymakers trying to respect patient preferences and improve their quality of care. The aim of the study is to determine if declining health status influences the end-of-life treatment preferences in Latino Medicare beneficiaries with cancer and how these preferences are modified by factors such as acculturation, health literacy, medical mistrust, provider ethnicity or the use of interpreters, or patient navigators. Participants will be 100 older Latino Medicare beneficiaries with breast, colorectal or prostate cancer, stage III or greater, and 100 contemporaries without cancer. Persons without cancer will be surveyed only once cross-sectionally and those with cancer will be interviewed at baseline and then monthly until twelve months or death to capture the preferences of both those who are undergoing rapid decline and those who are stable. Understanding the relationship between declining functional status and the treatment preferences of older Latinos with cancer has important clinical and policy implications, as findings could influence the use of written documents for advance care planning and inform the content and frequency of discussions that may be needed to capture changes in preferences triggered by changes in health status. We expect the proposed area of study and research that integrates palliative cancer care and health disparities research and applies prospective analytic methods to investigate a critical and understudied area to make a significant contribution to cancer care research. PUBLIC HEALTH RELEVANCE: End-of-Life Treatment Preferences of Latino Medicare Beneficiaries with Cancer Latinos are the fastest growing segment of the older population and new Latino cancer cases are predicted to double within the next twenty years. A person with cancer's choices to forgo life-extending treatment may change over time and as their health declines, yet identifying their choices related to one of life's most difficult periods is not always easy. This study will determine if the combination of declining health, cultural factors and meeting the cultural and language needs of Latino cancer patients, influence their end-of-life treatment choices.

描述（由申请人提供）：患有癌症的拉丁裔医疗保险受益人的临终治疗偏好 首席研究员：Isabel Torres, Dr.P.H. NCI K01 职业发展计划的总体目标是为候选人提供在姑息性癌症护理、健康差异和结果研究领域开展指导性研究活动和研究的计划，以开展独立的研究职业，专门从事这些领域的整合研究领域。该五年计划经过精心设计，目的是：1）在癌症姑息治疗、健康差异和卫生服务研究领域获得进一步的研究经验； 2) 通过先进统计方法的培训，提高与前瞻性姑息治疗研究的设计和分析相关的技能； 3) 提高开发和测试新仪器和绩效指标所需的技能，以提高评估英语和西班牙语拉丁裔癌症患者质量结果的准确性； 4) 获得进一步的资助写作技巧和经验，从而在支持期结束之前提交 R01 资助。正确识别癌症患者的临终偏好是国家医疗保健的首要任务，了解影响这些决策的临床、文化、心理社会和系统层面的因素对于试图尊重患者偏好并提高他们的治疗质量的临床医生和政策制定者来说至关重要。关心。该研究的目的是确定健康状况下降是否会影响患有癌症的拉丁裔医疗保险受益人的临终治疗偏好，以及这些偏好如何因文化适应、健康素养、医疗不信任、提供者种族或使用等因素而改变。口译员或耐心导航员。参与者将是 100 名患有乳腺癌、结直肠癌或前列腺癌 III 期或以上的老年拉丁裔医疗保险受益人，以及 100 名没有患癌症的同龄人。未患癌症的人将仅接受一次横断面调查，而患有癌症的人将在基线时接受采访，然后每月一次，直到十二个月或死亡，以了解正在经历快速衰退的人和稳定的人的偏好。了解老年癌症患者功能状态下降与治疗偏好之间的关系具有重要的临床和政策意义，因为研究结果可能会影响预先护理计划的书面文件的使用，并告知可能需要捕获的讨论的内容和频率健康状况的变化引发偏好的变化。我们期望拟议的研究领域能够整合姑息性癌症护理和健康差异研究，并应用前瞻性分析方法来调查关键和未充分研究的领域，从而为癌症护理研究做出重大贡献。 公共卫生相关性：患有癌症的拉丁裔医疗保险受益人的临终治疗偏好 拉丁裔是老年人口中增长最快的群体，预计未来二十年内新增拉丁裔癌症病例将翻一番。癌症患者放弃延长生命的治疗的选择可能会随着时间的推移和健康状况的恶化而改变，但确定他们的选择与生命中最困难的时期之一相关并不总是那么容易。这项研究将确定健康状况恶化、文化因素以及满足拉丁裔癌症患者的文化和语言需求的结合是否会影响他们的临终治疗选择。