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:
  • 金额:
    $ 34.2万
  • 依托单位:
  • 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

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).
项目概要 每年有近 600,000 名美国老年人死于癌症,维护人类尊严至关重要。 我们的长期目标是培养最佳的人文模式。 我们重点关注拟议的尊严疗法(DT)研究。 旨在保护癌症患者的尊严,尽管理论上他们的健康状况有所下降。 老年学生活回顾研究,DT 涉及治疗师指导患者产生自己独特的、 患者报告了 DT 的益处,但迄今为止 DT 的机制尚未阐明。 随着这种疗法的使用在国际上传播,迫切需要进行实证研究。 所提出的研究是第一个可靠地分析老年癌症内容的研究。 患者在 DT 疗程中与治疗师的互动(N=280 名接受 DT 的老年人)。 允许研究理论上对于通过 DT 改善患者尊严至关重要的两种机制。 提出的机制、DT 期间的同理心提供者与患者的沟通以及患者生活的丰富性 DT 期间产生的叙述将被分析用作治疗前后尊严变化的预测因素 我们提出的研究使用创新的方法论工具:它将采用互动和叙述。 基于患者自身经验的分析,以建立治疗影响的机制 过去的研究因评估接受 DT 的概念性远端结果而受到损害。 作为回应,所提出的结果已被选为由 DT 密切指导的近端结构 我们感兴趣的主要结果是患者的尊严感的程度。 拟议研究的另一个方面是调查测试前和测试后的差异(即尊严影响)。 当患者最有能力参与 DT 时,这将通过评估患者是否参与 DT 的程度来完成。 DT 后的尊严影响受到患者症状严重程度的影响,同时描述了机制和影响。 确定患者参与 DT 的最佳时机将为将 DT 作为一种治疗方法实施提供实质性进展 我们的跨学科团队确保研究结果能够为老年癌症患者提供一种心理社会护理。 旨在改善 DT 培训和交付,这包括我们创新的托管传播计划。 与国家意见领袖举行的护理科学峰会我们的具体目标如下: SA1:描绘护理科学峰会。 移情沟通与较高患者尊严影响(主要结果)前后之间的关系 SA2:调查引导患者产生的生活叙述的丰富性之间的关系。 DT期间,以及治疗前后的尊严影响(主要结果)。SA3:确定最适合的模型 患者与提供者的移情沟通与治疗后对患者尊严的影响之间的关系,以及叙述 丰富度作为中介变量,患者症状严重程度作为中介变量(即调节中介分析)。

项目成果

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SUSAN BLUCK其他文献

SUSAN BLUCK的其他文献

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{{ truncateString('SUSAN BLUCK', 18)}}的其他基金

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
  • 批准号:
    10487457
  • 财政年份:
    2021
  • 资助金额:
    $ 34.2万
  • 项目类别:

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