Behavioral and Psychosocial Effects on Study Outcomes in End-Stage Cancer Treatment (BEST End-Stage Cancer Study)

行为和社会心理对末期癌症治疗研究结果的影响（最佳末期癌症研究）

基本信息

批准号：
10681336
负责人：
Holly Gwen Prigerson
金额：
$ 94.95万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-01 至 2029-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10681336
关键词：
Academy Address Advance Care Planning Award Behavioral Cancer Patient Caregivers Caring Cause of Death Cessation of life Clinical Communication Data Decision Making Disclosure Disparity Distress Effectiveness Emotional Ensure Equity Family member Frequencies Inferior Inherited Intervention Love Malignant Neoplasms Medical Medicine Mental Health Oncologist Outcome Outcome Study Pain Patients Persons Prognosis Psychosocial Factor Public Health Research Research Personnel Resources Spiritual care Testing Treatment/Psychosocial Effects United States black patient cancer care cancer health disparity cancer risk cancer therapy chemotherapy end of life end of life care end stage disease ethnic minority population improved overtreatment palliate palliative chemotherapy patient prognosis prognostic psychosocial psychosocial adjustment racial minority population theories

项目摘要

Behavioral and Psychosocial Effects on Study Outcomes in End-Stage Cancer Treatment (aka, the BEST End-Stage Cancer Study) Project Summary Despite great strides that have been made in the understanding and treatment of cancer, the number of cancer deaths remains on the rise and cancer remains the 2nd leading cause of death in the United States (US). Not only is the number of people dying of cancer increasing, but the quality of those deaths is alarmingly poor. End-of-life (EoL) care in the US has been deemed a public health crisis by the National Academy of Medicine -- a conclusion bolstered by disturbing findings from my group. My research has shown that end-stage cancer patients receive chemotherapy troublingly close to death, that end-stage cancer patients are shockingly uninformed of their prognosis and the harms of EoL treatments, that racial/ethnic minority groups receive dramatically inferior EoL cancer care, and that severe emotional pain and suffering remain largely unchecked. The current Outstanding Investigator Award (OIA) research has identified and targeted psychosocial factors to address these problems; the results have proved paradigm-shifting and practice-changing. For example, we showed that: 1) “palliative chemotherapy” does not “palliate” and may actually do more harm than good -> highlighting the need for oncologists to recognize the harms of “overtreatment” and refrain from prescribing chemotherapy to patients they deem close to death; 2) oncologist prognostic communication can improve patient prognostic understanding and lead to more informed, value-concordant EoL care, but it occurs infrequently, and ineffectively –> our Oncolo-GIST approach as a simple, effective way oncologists can feel comfortable communicating the gist of a patient’s prognosis; 3) that “one size does not fit all” in addressing disparities in EoL cancer care->our Divine Intervention targeting black patients’ medical mistrust and spiritual care needs as a way to promote advance care planning (ACP); 4) that psychosocial distress is an important influence on, as much as outcome of, EoL decision-making->our EMPOWER psychosocial intervention targeting “experiential avoidance” to promote caregiver psychosocial adjustment and engagement in ACP. Going forward, this OIA will focus on: 1) oncologist communication; 2) cancer disparities; and 3) psychosocial distress. I will leverage data, theories,and the clinical and scholarly resources (colleagues and collaborators) developed under the auspices of the current OIA to: improve oncologist delivery of high quality EoL cancer care; increase the frequency and effectiveness of their prognostic disclosures; promote cancer patients’ prognostic understanding; ensure the equitable delivery of EoL cancer care; and reduce psychosocial distress of patients and caregivers to enhance their mental health and promote their engagement in ACP. Renewal of this OIA will enable me to conduct research helping to ensure that dying cancer patients and their caregivers receive the highest quality of EoL cancer care possible.

末期癌症治疗中研究结果的行为和社会心理影响（又名最好的终末期癌症研究）项目摘要尽管在理解和治疗癌症方面取得了长足的进步，但数量癌症死亡仍在上升，癌症仍然是曼联的第二大死亡原因国家（美国）。不仅死于癌症的人数增加，而且这些人的质量死亡令人震惊。美国在美国的临终关怀（EOL）护理已被认为是公共卫生危机美国国家医学院（National Academy of Medicine） - 这一结论是由我小组令人不安的发现得到的。我的研究表明，末期癌症患者接受化学疗法障碍接近死亡，那个末期癌症患者对他们的预后和EOL的危害令人震惊治疗方法，种族/族裔少数群体受到了较低的EOL癌症护理，并且严重的情绪痛苦和痛苦在很大程度上仍未受到检查。现任杰出调查员奖项（OIA）研究已确定并针对性的社会心理因素来解决这些问题；结果已证明范式变化并改变了练习。例如，我们表明：1） “姑息化疗”不会“ palliation”，实际上可能弊大于利 - >突出显示肿瘤学家需要认识到“过度治疗”的危害并避免开处方对患者的化学疗法，他们认为接近死亡； 2）肿瘤学家的预后交流可以提高患者的预后理解，并带来更明智的，价值的EOL护理，但它很少发生，并且无效地发生 - >我们的Oncolo-gist方法是一种简单，有效的方式肿瘤学家可以很乐意传达患者预后的要点。 3）“一个尺寸不符合所有内容” 患者的医疗不信任和精神护理需要作为促进预先护理计划的一种方式（ACP）; 4）这种心理困扰是对EOL的重要影响决策 - >我们的授权社会心理干预以“经验避免”为目标促进护理人员的心理社会调整和参与ACP。展望未来，这个OIA将会关注：1）肿瘤学家交流； 2）癌症差异； 3）社会心理困扰。我会利用数据，理论以及临床和科学资源（同事和合作者）在当前OIA的主持下开发以：改善高质量EOL的肿瘤学家的交付癌症护理；增加其预后披露的频率和有效性；促进癌症患者的预后理解；确保公平的EOL癌症护理；并减少患者和看护人的心理痛苦，以增强他们的心理健康并促进他们参与ACP。续签此OIA将使我能够进行研究，以确保垂死的癌症患者及其护理人员可以接受最高质量的EOL癌症护理。

项目成果

期刊论文数量（44）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Family Relationships and Psychosocial Dysfunction Among Family Caregivers of Patients With Advanced Cancer.

DOI：
10.1016/j.jpainsymman.2016.07.006
发表时间：
2016-12
期刊：
Journal of pain and symptom management
影响因子：
4.7
作者：
Nissen KG;Trevino K;Lange T;Prigerson HG
通讯作者：
Prigerson HG

Bereavement Follow-Up After the Death of a Child as a Standard of Care in Pediatric Oncology.

DOI：
10.1002/pbc.25700
发表时间：
2015-12
期刊：
Pediatric blood & cancer
影响因子：
3.2
作者：
Lichtenthal WG;Sweeney CR;Roberts KE;Corner GW;Donovan LA;Prigerson HG;Wiener L
通讯作者：
Wiener L

Associations between dementia diagnosis and end-of-life care utilization.

DOI：
10.1111/jgs.17952
发表时间：
2022-10
期刊：
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
影响因子：
6.3
作者：
Luth, Elizabeth A.;Manful, Adoma;Prigerson, Holly G.;Xiang, Lingwei;Reich, Amanda;Semco, Robert;Weissman, Joel S.
通讯作者：
Weissman, Joel S.

Evaluating Quality Metrics for the Care of Patients With Blood Cancer Who Are Near Death.

评估濒临死亡的血癌患者护理的质量指标。

DOI：
10.1200/jco.2016.68.8911
发表时间：
2016
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
0
作者：
Trevino,KellyM;Martin,Peter;Prigerson,HollyG
通讯作者：
Prigerson,HollyG

Reply to Serin et al.

回复 Serin 等人。