Psychosocial Approaches to Better Understanding & End-Stage Cancer Care (PROTECT)

更好地理解的社会心理方法

• 批准号: 9379104
• 负责人: Holly Gwen Prigerson
• 金额: $ 20.98万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9379104
• 关键词: Advance Care Planning; Award; Cancer Patient; Caregivers; Cause of Death; Cessation of life; Clinical; Cognitive; Communication; Data; Data Set; Databases; Development; Emotional; Ethnic Origin; Family member; Foundations; Funding; Future; Gender; Impact evaluation; Institute of Medicine (U.S.); Intervention; Intervention Trial; Link; Malignant Neoplasms; Measurement; Medicare claim; Observational Study; Outcome; Patients; Phase; Process; Prospective cohort study; Psychosocial Factor; Public Health; Quality of life; Race; Readiness; Religious Belief; Research; Site; Terminal Disease; Translating; United States; anticancer research; cancer care; coping; cost; disparity reduction; end of life; end of life care; ethnic disparity; gender disparity; health literacy; health service use; improved; novel; outcome forecast; programs; psychologic; psychosocial; public health relevance; quality of death; racial disparity; social; therapy development; tool

 DESCRIPTION (provided by applicant): Cancer is a leading cause of death in the United States and the number of cancer deaths is growing. In 2014, the Institute of Medicine concluded that increasingly aggressive, burdensome and expensive end-of-life (EoL) care was a major public health problem that needed to be fixed. Dr. Prigerson's NCI-funded Coping with Cancer (CwC) studies point to potentially powerful psychosocial solutions to problems in the delivery of EoL cancer care. This R35 award will afford her the opportunity to translate the foundational observational research findings from her multi-site, longitudinal R01 CwC studies, funded continuously by NCI since 2002, into interventional trials to improve EoL cancer care. In Phase I of this program of research, Dr. Prigerson will develop the necessary research tools and build the capacity to advance the intervention development projects in Phase II. Specifically, Phase I projects will focus on the development and refinement of scales to assess targets and outcomes of psychosocial interventions in EoL cancer care, including a) patient and caregiver psychological readiness to process information communicated about prognosis (e.g., emotional acceptance of the patient's terminal prognosis); b) patient and caregiver understanding of illness and EoL treatment options (aka cognitive acceptance of the patient's terminal prognosis and EoL health literacy); and c) the patient's quality of life at the EoL (aka quality of death). PhaseI projects will also devise and establish databases that link existing CwC prospective cohort study data, and future psychosocial intervention trial data, to Medicare claims data to perform accurate, comprehensive evaluations of the impact of psychosocial factors and interventions on health service use and costs in EoL cancer care. Phase II projects will use these measurement tools and impact assessments to develop psychosocial interventions that target: a) illness and treatment understanding at the EoL, b) barriers to advance care planning, c) improvements in EoL outcomes, and d) reduction of racial, ethnic and gender disparities in EoL outcomes. Phase II projects will develop psychosocial interventions that incorporate and enhance proven strategies to promote emotional and cognitive acceptance of terminal illness and understanding of treatment options, apply notions of "social proofing" to improve EoL clinical communication, and contextualize religious beliefs (e.g., in miracles) to reduce disparities in EoL cancer care. This program of research is expected to yield novel and refined measurement tools for EoL cancer research, comprehensive datasets that link and relate psychosocial factors and interventions data to comprehensive health service use and costs data in EoL cancer care, and psychosocial interventions to promote understanding and better EoL outcomes for all cancer patients and their family members, regardless of their race, ethnicity or gender.

 描述（由适用提供）：癌症是美国的主要死亡原因，癌症死亡人数正在增加。 2014年，医学研究所得出结论，越来越激进，朴实和昂贵的寿命（EOL）护理是需要解决的主要公共卫生问题。 Prigerson博士的NCI资助应对癌症（CWC）研究指出，对于EOL癌症护理的交付问题，潜在强大的社会心理解决方案。这项R35奖将使她有机会将其多站点纵向R01 CWC研究的基础观察性研究结果转化为NCI自2002年以来不断资助的介入试验，以改善EOL癌症护理。在该研究计划的第一阶段，Prigerson博士将开发必要的研究工具，并建立推进II期干预开发项目的能力。具体而言，第一阶段项目将重点关注量表的开发和完善，以评估EOL癌症护理中心理心理干预措施的目标和结果，包括a）患者和看护人心理准备，以处理有关预后传达的信息（例如，对患者终末预后的情感接受）； b）患者和护理人员对疾病和EOL治疗方案的了解（又称患者终末预后的认知接受和EOL健康素养）； c）患者在EOL的生活质量（又称死亡质量）。 Chasei项目还将设计和建立数据库，以将现有的CWC前瞻性队列研究数据以及未来的心理干预试验数据与Medicare索赔数据联系起来，以对社会心理因素的影响以及对卫生服务的影响以及EOL癌症护理中的健康服务使用和成本进行准确，全面的评估。第二阶段项目将使用这些测量工具和影响评估来开发针对的社会心理干预措施：a）EOL的疾病和治疗理解，b）提高护理计划的障碍，c）EOL结果的改善，d）减少EOL成果中种族，种族和性别分布。第二阶段项目将开发社会心理干预措施，纳入并增强了良好的策略，以促进对绝症的情绪和认知的接受，并了解治疗方案，应用“社会证明”的概念来改善EOL临床交流，并在奇迹（例如，在奇迹中）将EOL癌症护理中的分布降低。预计该研究计划将为EOL癌症研究提供新颖和精致的测量工具，将与全面的心理社会因素和干预数据联系到EOL癌症护理中的全面卫生服务使用和成本数据，以及为所有癌症患者及其家庭成员带来更好的EOL成果，无论其竞赛，无论他们的种族，无论是竞赛，无论是竞赛，而与他们的竞争，无论是他们的种族，无论是竞赛，而与他们的竞赛，无论是竞赛》，无论是在EOL癌症护理中的全面数据和成本。