Latino vs. Non-Latino Disparities in Advance Care Planning & End-of-Life Care

拉丁裔与非拉丁裔在预先护理计划方面的差异

• 批准号: 8934132
• 负责人: Paul K Maciejewski
• 金额: $ 41.47万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-25 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8934132
• 关键词: Address; Advance Care Planning; Advance Directives; Advanced Malignant Neoplasm; Affect; African American; Belief; Cancer Patient; Caregivers; Caring; Cause of Death; Cessation of life; Chicago; Clinic; Communities; Conflict (Psychology); Data; Decision Making; Development; Do Not Resuscitate Order; Elements; Ethnic group; Family; Family Caregiver; Focus Groups; Goals; Health; Healthcare; Healthcare Power of Attorney; Hospice Care; Inferior; Influentials; Intensive Care; Intervention; Latino; Life; Living Wills; Malignant Neoplasms; Mediating; Mediator of activation protein; Medical; New York City; Observational Study; Outcome; Patients; Phase; Physicians; Play; Provider; Quality of life; Recruitment Activity; Religion and Spirituality; Religious Belief; Research; Resuscitation; Role; Secrecy; Services; Spouses; Terminally Ill; Testing; Therapeutic; Trust; United States; authority; cancer pain; design; end of life; hospice environment; interest; oncology; palliative; preference; therapy development

DESCRIPTION (provided by applicant): In this project, we aim to explain and reduce Latino/non-Latino disparities in advance care planning (ACP) and end-of-life (EOL) care. Latino advanced cancer patients are less likely than non-Latino advanced cancer patients to engage in ACP - a practice to help terminally ill patients and their families achieve EOL goals of care. Consistent with this disparity in ACP, Latino advanced cancer patients receive aggressive, burdensome EOL care more often than do their non-Latino counterparts. They are also less likely than others to use hospice services and to receive EOL care in line with their preferences. Consequently, the EOL care that Latino advanced cancer patients receive appears to be suboptimal, inferior to the care that non-Latino patients receive, infrequently guided by ACP, and often counter to their values. In this project, we will address these disparities in ACP & EOL care through two closely related sub-projects. In the first of these sub-projects, we aim to identify beliefs that contribute to Latino/non-Latino disparities in ACP & EOL care (Specific Aim 1). We will conduct an observational study of beliefs, ACP and EOL outcomes in 400 advanced cancer patients (N=200 Latino; N=200 non-Latino) and their informal caregivers (e.g., spouses; N=400) whom we will recruit from clinics in New York City, Dallas, and Chicago. In this observational study, we will examine the extent to which religious, familial and cultural medical beliefs mediate or moderate Latino/non-Latino disparities in ACP & EOL care, and identify significantly influential beliefs as potential targets of an intervention to reduce those disparitis. In the second sub-project, using results from this observational study as a guide, we aim to develop and pilot a belief-contextualization intervention to reduce Latino/non-Latino disparities in ACP & EOL care (Specific Aim 2). Specific Aim 2 will proceed in three phases. In Phase I, we will briefly review results of Specific Aim 1 and ask Latino stakeholders to provide input on possible belief-contextualization interventions to determine those likely to be most effective in, and acceptable to, Latino communities. In Phase II, we will design a belief-contextualization intervention to reduce Latino/non-Latino disparities in ACP & EOL care that incorporates elements identified in Phase I and then vet that intervention with a separate group of Latino stakeholders. In Phase III, we will evaluate the feasibility and potential efficacy of the belief-contextualization intervention developed in Phase II. Overall, results of this study will identify influential beliefs that explain Latino/non-Latino disparities in ACP & EOL care, and offer the promise of an effective approach to the reduction of Latino/non-Latino disparities in ACP, and, ultimately, EOL care.

描述（由申请人提供）：在此项目中，我们旨在在预先护理计划（ACP）和寿命终止（EOL）护理中解释和减少拉丁裔/非拉丁裔差异。拉丁裔晚期癌症患者的可能性少于非拉丁裔晚期癌症患者参与ACP的可能性，这是一种实践，可以帮助绝症患者及其家人实现EOL护理目标。与ACP中的这种差异一致，拉丁裔晚期癌症患者比非拉丁裔同行更频繁地获得侵略性，繁重的EOL护理。与其他人使用临终关怀服务并符合其偏好相一致的EOL护理的可能性也少。因此，Latino晚期癌症患者接受的EOL护理似乎是最佳的，不如非Latino患者接受的护理，不经过ACP的指导，并且通常与其值相反。在这个项目中，我们将通过两个密切相关的子项目解决ACP＆EOL护理中的这些差异。在这些子项目中的第一个中，我们旨在确定有助于ACP＆EOL护理中拉丁裔/非拉丁裔差异的信念（特定目标1）。我们将对400名晚期癌症患者（n = 200 latino; n = 200非拉丁裔）及其非正式护理人员（例如配偶； n = 400）的信念，ACP和EOL结果进行观察研究。在这项观察性研究中，我们将研究ACP＆EOL护理中的宗教，家族和文化医学信念在ACP＆EOL护理中介导或中度的拉丁裔/非拉丁裔差异，并确定有影响力的信念是减少这些异常炎的干预措施的潜在目标。在第二个子项目中，使用这项观察性研究的结果作为指导，我们旨在开发和试行一种信念上下文化的干预措施，以减少ACP＆EOL护理中的拉丁裔/非拉丁裔差异（特定目标2）。具体目标2将分为三个阶段。在第一阶段，我们将简要审查特定目标1的结果，并要求拉丁裔利益相关者就可能的信念上下文化干预措施提供意见，以确定可能在拉丁裔社区中最有效，可以接受的那些。在第二阶段中，我们将设计一种信念上下文的干预措施，以减少ACP＆EOL护理中的拉丁裔/非拉丁裔差异，该干预措施结合了I阶段中确定的元素，然后将其与单独的一组拉丁裔利益相关者进行审查。在第三阶段中，我们将评估II期信仰无关干预措施的可行性和潜在功效。总体而言，这项研究的结果将确定有影响力的信念，这些信念解释了ACP＆EOL护理中的拉丁裔/非拉丁裔差异，并提供了有效方法来减少ACP中拉丁裔/非拉丁裔差异的希望，并最终提供EOL护理。