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.

行为和心理社会对晚期癌症治疗研究结果的影响（又名最佳末期癌症研究）项目概要尽管在对癌症的认识和治疗方面取得了巨大进步，但癌症的数量癌症死亡人数仍在上升，癌症仍然是美国第二大死因各州（美国）不仅死于癌症的人数在增加，而且死亡人数的质量也在增加。美国的临终关怀（EoL）状况极其糟糕，已被视为公共卫生危机。美国国家医学院——我的团队令人不安的发现支持了这一结论。研究表明，接受化疗的末期癌症患者接近死亡，令人震惊的是，终末期癌症患者对其预后和 EoL 的危害一无所知治疗，少数种族/族裔群体接受的临终癌症护理严重较差，并且严重的情感痛苦和痛苦在很大程度上仍未得到控制。奖 (OIA) 研究已确定并针对社会心理因素来解决这些问题；结果证明了范式转变和实践改变，例如，我们表明：1） “姑息化疗”并不能“缓解”，实际上可能弊大于利 -> 强调肿瘤学家需要认识到“过度治疗”的危害并避免开处方对他们认为濒临死亡的患者进行化疗；2) 肿瘤科医生的预后沟通可以提高患者对预后的了解并带来更知情、价值一致的 EoL 护理，但是它很少发生，而且效率低下 –> 我们的 Oncolo-GIST 方法是一种简单、有效的方法肿瘤学家可以轻松地传达患者预后的要点 3) “统一；在解决临终癌症护理方面的差异方面，“并不适合所有人”->我们针对黑人的神圣干预患者的医疗不信任和精神护理需求是促进预先护理计划的一种方式 (ACP)；4) 社会心理困扰对 EoL 和结果都有重要影响决策->我们的 EMPOWER 心理社会干预以“体验性回避”为目标展望未来，该 OIA 将促进心理护理人员的社会适应和参与。重点关注：1）肿瘤科医生沟通；2）癌症差异；3）社会心理困扰。利用数据、理论以及临床和学术资源（同事和合作者）在当前 OIA 的支持下开发的目的是：改善肿瘤科医生提供高质量的 EoL 癌症护理；提高预后披露的频率和有效性；患者对预后的了解；确保公平地提供终止期癌症护理；患者和护理人员的心理社会困扰，以增强他们的心理健康并促进他们的参与 ACP 的更新将使我能够进行研究，帮助确保：垂死的癌症患者及其护理人员可以获得最高质量的临终癌症护理。

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）

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

儿童死亡后的丧亲后续行动作为儿科肿瘤学的护理标准。

DOI：
发表时间：
2015-12
期刊：
影响因子：
3.2
作者：
Lichtenthal, Wendy G;Sweeney, Corinne R;Roberts, Kailey E;Corner, Geoffrey W;Donovan, Leigh A;Prigerson, Holly G;Wiener, Lori
通讯作者：
Wiener, Lori

Discussions of Life Expectancy and Changes in Illness Understanding in Patients With Advanced Cancer.

晚期癌症患者的预期寿命和疾病理解变化的讨论。

DOI：
发表时间：
2016
期刊：
影响因子：
0
作者：
Epstein, Andrew S;Prigerson, Holly G;O'Reilly, Eileen M;Maciejewski, Paul K
通讯作者：
Maciejewski, Paul K

Prognostic awareness, prognostic communication, and cognitive function in patients with malignant glioma.

恶性胶质瘤患者的预后意识、预后沟通和认知功能。

DOI：
发表时间：
2017-10-19
期刊：
影响因子：
15.9
作者：
Diamond, Eli L;Prigerson, Holly G;Correa, Denise C;Reiner, Anne;Panageas, Katherine;Kryza;Buthorn, Justin;Neil, Elizabeth C;Miller, Alex M;DeAngelis, Lisa M;Applebaum, Allison J
通讯作者：
Applebaum, Allison J

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

痴呆症诊断与临终关怀利用之间的关联。

DOI：
发表时间：
2022-10
期刊：
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

Communication Skills Training for Oncology Clinicians After the 21st Century Cures Act: The Need to Contextualize Patient Portal-Delivered Test Results.

《21 世纪治愈法案》之后肿瘤学临床医生的沟通技巧培训：需要将患者门户提供的测试结果置于情境中。