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带配偶或密友去看病，但患者决策的社会层面的研究相对较少。当非裔美国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病、死亡率、护理和治愈的态度和信念，以影响患者做出的决定，包括是否参加临床试验。本研究的目标是开发一个人际框架，以阐明社会关系如何影响非裔美国患者做出肺癌护理决策的方式。肺癌是美国癌症死亡的主要原因；男性总体死亡率估计为 72%，女性总体死亡率为 41%。非裔美国患者的结果更糟，他们通常在较年轻的时候被诊断出来，病情更严重，合并症也更严重。特别是非小细胞肺癌，通常在晚期才被诊断出来，导致预后不良。即使在总体生存率较低的情况下，疾病本身表现方式的差异也会产生多种治疗选择。当非裔美国患者与重要的其他人权衡此类治疗选择时，我们需要了解这些对话如何影响患者的态度和信念，以影响患者的决定，包括是否参加临床试验。尽管几种不同的行为结构探索了社会支持和社会影响的维度，但它们不足以充分描述患者和重要他人在医生办公室外谈论决策时的实际动态。本研究将评估这些不同结构对人际决策的适用性，然后利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。具体研究目标是： 1) 开发一个人际决策的初步框架，其中包含适用的行为结构（例如感知与实施的社会支持、社会影响、二元应对），以描述患者之间的即时互动及其他重要人士； 2) 使用框架结构对诊断后 18 个月的非裔美国肺癌患者 (n=100) 进行调查； 3) 使用在家里或社区进行的三个时间点（诊断后、治疗、术后护理；n= 60 次访谈）对 20 名患者及其配偶的子样本进行联合访谈的定性数据来完善框架。这项研究意义重大，因为它将行为理论与患者报告的经验数据相结合，以调查医疗决策的一个重要维度。研究结果将导致基于证据的心理社会干预措施，以减少非裔美国人肺癌的治疗结果差异。