Dignity Therapy for Older Cancer Patients: Identifying Mechanisms and Moderators

老年癌症患者的尊严治疗：确定机制和调节因素

基本信息

批准号：
10298222
负责人：
SUSAN BLUCK
金额：
$ 34.2万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-10 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10298222
关键词：
Affect American Awareness Cancer Patient Caring Cessation of life Client satisfaction Clinical Communication Consensus Data Analyses Distal Distress Elderly Empathy Ensure Face Feasibility Studies Fostering Foundations Gerontology Goals Health Healthcare Healthcare Systems Hearing Individual Institutes International Investigation Life Malignant Neoplasms Measures Mediating Mediation Mediator of activation protein Methodology Methods Modeling Oncology Outcome Palliative Care Patient Care Patients Plant Roots Process Prognosis Provider Psychosocial Assessment and Care Quality of life Reporting Research Science Severities Site Statistical Data Interpretation Structure Symptoms Training Transcript analytical tool brief intervention cancer care clinical center cost design end of life experience group intervention human dignity improved innovation interest patient engagement patient oriented patient-clinician communication preservation pressure primary outcome psychosocial response secondary outcome symposium therapy outcome tool

Affect American Awareness Cancer Patient Caring Cessation of life Client satisfaction Clinical Communication Consensus Data Analyses Distal Distress Elderly Empathy Ensure Face Feasibility Studies Fostering Foundations Gerontology Goals Health Healthcare Healthcare Systems Hearing Individual Institutes International Investigation Life Malignant Neoplasms Measures Mediating Mediation Mediator of activation protein Methodology Methods Modeling Oncology Outcome Palliative Care Patient Care Patients Plant Roots Process Prognosis Provider Psychosocial Assessment and Care Quality of life Reporting Research Science Severities Site Statistical Data Interpretation Structure Symptoms Training Transcript analytical tool brief intervention cancer care clinical center cost design end of life experience group intervention human dignity improved innovation interest patient engagement patient oriented patient-clinician communication preservation pressure primary outcome psychosocial response secondary outcome symposium therapy outcome tool

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项目摘要

PROJECT SUMMARY Nearly 600,000 older Americans die a cancer-related death each year. Maintaining human dignity is central to quality of life for patients with serious illness. Our long-term goal is to foster optimal humanistic modes of patient-centered clinical communication. We focus in the proposed study on Dignity Therapy (DT) which was designed to preserve cancer patients’ dignity despite declines in their health. Theoretically grounded in gerontological life review research, DT involves a therapist guiding a patient to generate their own unique, structured life narrative. Patients report benefits of DT but to date the mechanisms of DT have not been empirically investigated. As the use of this therapy spreads internationally, there is thus a pressing need to delineate precise mechanisms. The proposed study is the first to reliably analyze the content of older cancer patients’ interactions with the therapist in DT sessions (N=280 older adults who received DT). Our design allows for investigation of two mechanisms theoretically central to improving patient dignity through DT. These proposed mechanisms, empathic provider-patient communication during DT and richness of the patient’s life narrative produced during DT, will be used analytically as predictors of pre-to-post-therapy change in dignity impact. Our proposed study uses innovative methodological tools: it will employ both interactional and narrative analysis, grounded in the patient’s own experience, to establish mechanisms through which the therapy affects patient dignity. Past research has suffered due to assessment of conceptually distal outcomes of receiving DT. In response, the proposed outcomes have been chosen as proximal constructs closely guided by DT’s conceptual underpinnings. Our primary outcome of interest is the extent to which the patients sense of dignity increases from pre-to-posttest (i.e., Dignity Impact). Another aspect of the proposed study is to investigate when patients are most able to engage in DT. This will be accomplished through assessing whether extent of dignity impact after DT is moderated by patients’ symptom severity. Together, delineating mechanisms and identifying best timing for patient engagement in DT will provide substantial progress in implementing DT as a form of psychosocial care for older cancer patients. Our interdisciplinary team ensures that study findings will be implemented to improve DT training and delivery. This includes our innovative dissemination plan of hosting a Science of Care Summit with national opinion leaders. Our specific aims are as follows: SA1: Delineate the relation between empathic communication and higher patient dignity impact (primary outcome) pre-to-post- therapy. SA2: Investigate the relation between richness of the life narrative the patient is guided to produce during DT, and dignity impact (primary outcome) pre-to-post therapy.SA3: Identify the best-fitting model of relation of patient-provider empathic communication to post-therapy impact on patients’ dignity, with narrative richness as a mediator and patients’ symptom severity as a moderator (i.e., moderated-mediation analyses).

项目摘要每年将近60万名美国人死亡与癌症有关的死亡。维持人的尊严是患有严重疾病的患者的生活质量。我们的长期目标是培养最佳的人文主义模式以患者为中心的临床交流。我们专注于拟议的关于尊严治疗（DT）的研究旨在保护癌症患者的尊严使命的健康状况下降。理论上扎根老年生命评论研究，DT涉及一名治疗师指导患者产生自己独特的，结构化的生活叙事。患者报告了DT的好处，但迄今为止，DT的机制尚未经验研究。随着这种疗法的使用在国际上传播，因此有必要描述精确的机制。拟议的研究是第一个可靠地分析旧癌症含量的研究。患者在DT课程中与治疗师的相互作用（n =接受DT的280名老年人）。我们的设计允许对通过DT提高患者尊严提高患者尊严的两种机制进行投资。这些拟议的机制，DT期间的移情提供者与医生交流以及患者一生的丰富性在DT期间产生的叙述将在分析上用作尊严前进行验证变化的预测指标影响。我们提出的研究使用创新的方法论工具：它将采用互动和叙事分析以患者自身的经验为基础，以建立治疗影响的机制患者尊严。过去的研究因评估接受DT的概念远端结果而受到影响。作为回应，已选择拟议的结果作为由DT的密切指导的代理结构概念上的基础。我们感兴趣的主要结果是患者的忠诚感的程度从前到遗物的增加（即尊严影响）。拟议的研究的另一个方面是调查当患者最能够参与DT时。这将通过评估是否范围 DT后的尊严影响由患者的症状严重程度缓解。一起描绘机制和确定患者参与DT的最佳时机将在实施DT作为一个癌症患者的社会心理护理形式。我们的跨学科团队确保学习发现将实施以改善DT培训和交付。这包括我们托管的创新传播计划与国家意见领袖的护理科学峰会。我们的具体目的如下：SA1：描述移情沟通与较高的患者命运性影响（主要结果）之间的关系治疗。 SA2：调查生活叙事的丰富性之间的关系。在DT期间，尊严影响（主要结果）前至第一个疗法。SA3：确定最合适的模型患者支持者的移情沟通与治疗后对患者尊严的影响的关系，叙述作为调解人的丰富度和患者的症状严重程度作为主持人（即，调节分析）。