Latino End-of-Life Care: Patient, Provider, & Institutional Effects

拉丁裔临终关怀：患者、提供者、

• 批准号: 8294982
• 负责人: Holly Gwen Prigerson
• 金额: $ 71.1万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8294982
• 关键词: Accounting; Acculturation; Address; Autopsy; Benefits and Risks; Boston; Cancer Patient; Caring; Collaborations; Data; Enrollment; Ethnic Origin; Goals; Healthcare; Holly; Hospice Care; Inferior; Influentials; Institution; Intervention; Knowledge; Latino; Leadership; Life; Life Expectancy; Linear Models; Malignant Neoplasms; Malignant neoplasm of gastrointestinal tract; Malignant neoplasm of thorax; Medical; Outcome; Participant; Patient Care; Patients; Policy Maker; Procedures; Provider; Psychological Models; Quality of life; Recruitment Activity; Relative (related person); Religion and Spirituality; Research; Research Personnel; Resuscitation; Running; Sampling; Site; Specialist; Statistical Methods; Survey Methodology; Texas; Therapeutic; Training; Variant; Work; abstracting; base; coping; cost; end of life; ethnic minority population; health literacy; hospital bed; interest; oncology; preference; prevent; professor; prognostic; racial and ethnic disparities; regional difference; skills; social; therapy design

Abstract: Latinos receive more aggressive, burdensome end-of-life (EOL) care (eg, ICU stays, resuscitation) and less hospice care than non-Latino whites. The available evidence suggests that the EOL care Latinos receive may be suboptimal and inconsistent with their wishes, and inferior to the EOL care that whites receive. The overarching aim of this study is to identify the most promising targets for interventions designed to enable Latinos to receive: a) high quality EOL care, and b) care consistent with their values and preferences ("treatment goal attainment"). Our preliminary results, and those of others, suggest that there is a critical need for data at institutional, provider, and patient levels so that their relative influence can be discerned. The primary aims ofthe proposed study are to obtain multi-level data and use hierarchical linear modeling (HLM) to estimate patient, provider and institutional effects on Latino-white disparities in EOL care and treatment goal attainment. We hypothesize the primacy of patient and provider over institution effects, which will be significant, but less influential than either patient or provider effects. We will recruit 250 advanced gastrointestinal and thoracic cancer patients (125 Latino, 125 non-Latino white) with a life-expectancy of less than 6 months from five sites across the US. We will also enroll 50 oncology providers overall who each care for at least 5 study participants The patient's medical care received in the last month of life will be documented via medical chart extraction in the postmortem assessment. We anticipate that this study will inform policy makers and institutional leadership of where they should invest for the greatest "bang for the buck" to reduce Latino-white disparities in EOL care. The study team, comprised of Dr. Holly Prigerson, a leading expert in EOL care, and Dr. Jan Mutchler, a nationally recognized gerontologist with strong interests in disparities, is well-poised to undertake this work, in collaboration with a junior investigator at DFCI (Jimenez) and a UMB Associate Professor who wants to increase her research skills and expertise (Rivera). This project will benefit significantiy from support provided by the Training and Survey and Statistical Methods Cores.

摘要：拉美裔人比非拉丁裔白人获得了更具侵略性，繁重的寿命（EOL）护理（例如，ICU留下来，复苏）和更少的临终关怀护理。现有证据表明，Latinos接受的EOL护理可能是次优的，并且与他们的意愿不一致，并且不如白人所获得的EOL护理。 这项研究的总体目的是确定旨在使拉丁美洲人接受的干预措施的最有希望的目标：a）高质量的EOL护理，b）符合其价值和偏好一致的护理（“治疗目标达成”）。我们的初步结果以及其他结果表明，在机构，提供者和患者水平上对数据有至关重要的需求，以便可以识别其相对影响。主要 拟议研究的目的是获取多级数据并使用分层线性建模（HLM）来估计患者，提供者和机构对EOL护理和治疗目标实现拉丁裔白人差异的影响。 我们假设患者和提供者在机构影响方面的首要地位，这将是重要的，但影响力不如患者或提供者效应。我们将从美国招募250名晚期胃肠道和胸癌患者（125名拉丁裔，125个非拉丁裔白色），寿命少于6个月。我们还将注册50个肿瘤学提供者，每个人都关心至少5位研究参与者 生命最后一个月接受的患者医疗服务将通过验尸评估中的医疗图表进行记录。我们预计，这项研究将为政策制定者和机构领导层提供信息，以便在何处投资最大的“抢购”，以减少Latino-White Care中的拉丁美洲白人差异。 该研究团队由EOL护理领先的领先专家Holly Prigerson博士组成，并且与DFCI（Jimenez）的初级调查员合作，一位全国认可的具有浓厚差异兴趣的老年医生Jan Mutchler博士进行了这项工作，并希望提高研究技能和熟练的研究能力和熟练的研究能力（Jimenez）（Jimenez）。该项目将从培训，调查和统计方法核心提供的支持中受益。