Palliative Care for High-Grade Glioma

高级别胶质瘤的姑息治疗

基本信息

批准号：
10455638
负责人：
Rita Caroline Crooms
金额：
$ 16.9万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
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：
2021-08-01 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10455638
关键词：
Address Adult Advance Care Planning Affect Age Aging American Society of Clinical Oncology Attitude Cancer Patient Caregiver support Caregivers Caring Certification Cessation of life Clinical Communication Complex Continuity of Patient Care Development Plans Diagnosis Disease Distress Elderly Ensure Equilibrium Ethics European Family Foundations Future Geriatrics Glioma Goals Headache Health Care Costs Impaired cognition Incidence Interview K-Series Research Career Programs Knowledge Learning Life Expectancy Literature Malignant - descriptor Malignant Neoplasms Malignant neoplasm of brain Measures Medical Records Mentors Modeling Morbidity - disease rate National Comprehensive Cancer Network Nausea Neurobehavioral Manifestations Neurologic Neurologic Symptoms Nociception Oncologist Oncology Pain Palliative Care Palliative Medicine Patient Care Patients Pattern Perception Persons Primary Brain Neoplasms Principles of law and justice Process Prognosis Provider Psychosocial Assessment and Care Qualitative Methods Qualitative Research Quality of life Randomized Controlled Trials Religion and Spirituality Research Research Methodology Research Personnel Rotation Seizures Service delivery model Services Societies Source Specialist Structure Symptoms System Time Training Vulnerable Populations Work base cancer palliative treatment cancer therapy care delivery care providers care systems career career development cohort common symptom cultural competence data registry design end of life end of life care experience falls functional decline health care delivery health care service utilization human old age (65+)implementation science improved medical specialties multidisciplinary neoplasm registry older patient palliative physical symptom preference prevent psychologic psychological symptom psychosocial satisfaction service delivery shared decision making skills social stem symptom management symptomatic improvement treatment planning

项目摘要

Brief Summary WHO Grade III and IV gliomas (high-grade glioma or HGG) are aggressive, malignant primary brain tumors that are devastating for older adult patients and caregivers due to high symptom burden, early physical and cognitive decline, caregiver support needs, and existential distress stemming from life expectancy on the order of months. Palliative care, defined by the National Quality Forum as “patient and family-centered care that optimizes quality of life by anticipating, preventing, and alleviating suffering across the continuum of a patient's illness”, is well-suited to meet the complex needs of these patients. Multiple oncological societies recommend that palliative care be integrated early (within 3 months of diagnosis) into the treatment plan of all cancer patients. Older adults have particularly high palliative care needs, in part due to shorter prognosis and decreased tolerance for standard cancer-directed therapy. Generally, palliative care needs may be addressed through a combination of primary palliative care (delivered by any front-line provider, including neuro- oncologists) and/or specialty palliative care (delivered by a provider or multidisciplinary team with advanced palliative care training and certification). The current literature suggests that patients with HGG do not have all their palliative care needs met through primary palliative care from neuro-oncologists, yet they also are not referred to specialty palliative care until they are actively dying. There is no established model for ensuring their palliative care needs are met throughout the disease course. In this proposal, I present a conceptual model of the barriers to comprehensive, timely palliative care for patients with HGG. My career goal is to improve the delivery of palliative care for older adults with HGG. In this proposal I will: 1) use qualitative methods to assess the range of knowledge, experience, and strength of preferences of older adults with HGG, their caregivers, neuro-oncologists, and palliative medicine specialists regarding the domains of palliative care and the optimal balance of primary and specialty palliative care for each domain; 2) use an existing cohort of patients with HGG from a large health delivery system to measure the extent to which services or care processes in each palliative care domain are delivered, and to analyze the associations between palliative care delivery and overall HGG health care utilization. These two projects will be combined with my career development plan, for which I have identified a team of expert mentors and advisors and am proposing coursework relating to qualitative research methods and implementation science, as well as clinical rotations and didactic learning about core concepts in geriatrics and aging research. This will set me on a path to obtain a future career development award, which is the first step on my path to becoming an independent investigator whose work improves the care of older adults with HGG.

简要总结世界卫生组织 III 级和 IV 级神经胶质瘤（高级别神经胶质瘤或 HGG）是侵袭性恶性原发性脑肿瘤由于症状负担重、早期身体和身体状况不佳，这对老年患者和护理人员来说是毁灭性的认知能力下降、照顾者支持需求以及预期寿命造成的生存困扰国家质量论坛将姑息治疗定义为“以患者和家庭为中心的护理”。通过预测、预防和减轻患者整个过程中的痛苦来优化生活质量疾病”，非常适合满足这些患者的复杂需求。多个肿瘤学会推荐。姑息治疗应尽早（诊断后 3 个月内）纳入所有癌症的治疗计划老年人对姑息治疗的需求特别高，部分原因是预后较短和对标准癌症定向治疗的耐受性降低一般来说，姑息治疗需求可以得到解决。通过初级姑息治疗的组合（由任何一线提供者提供，包括神经- 肿瘤科医生）和/或专业姑息治疗（由具有先进技术的提供者或多学科团队提供）姑息治疗培训和认证）目前的文献表明，HGG 患者并不具备所有这些能力。他们的姑息治疗需求通过神经肿瘤学家的初级姑息治疗得到满足，但他们也没有转至专业姑息治疗直至他们即将死亡没有既定的模型可以确保他们的生命安全。在这个提案中，我提出了一个概念，即在整个疾病过程中满足他们的姑息治疗需求。为 HGG 患者提供全面、及时的姑息治疗的障碍模型我的职业目标是改善 HGG 老年人的姑息治疗服务在本提案中，我将： 1) 使用定性治疗。评估患有 HGG 的老年人的知识范围、经验和偏好强度的方法，他们的护理人员、神经肿瘤学家和姑息医学专家关于姑息治疗领域的信息以及每个领域的初级和专业姑息治疗的最佳平衡 2) 使用现有的队列；来自大型医疗服务系统的 HGG 患者可以衡量服务或护理的程度提供每个姑息治疗领域的流程，并分析姑息治疗之间的关联交付和整体 HGG 医疗保健利用这两个项目将与我的职业生涯结合起来。发展计划，为此我已经确定了一个专家导师和顾问团队，并提出与定性研究方法和实施科学以及临床轮转相关的课程以及关于老年病学和衰老研究核心概念的教学学习这将使我走上一条获得知识的道路。未来职业发展奖，这是我成为独立调查员的第一步他们的工作改善了患有 HGG 的老年人的护理。