Impact of Specialist Palliative Care on Outcomes in Advanced Stage Lung Cancer

专科姑息治疗对晚期肺癌预后的影响

• 批准号: 9318461
• 负责人: Donald R Sullivan
• 金额: $ 16.52万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-21 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9318461
• 关键词: Address; Admission activity; Advance Care Planning; Advanced Malignant Neoplasm; American; Award; Cancer Etiology; Cancer Patient; Caring; Clinical; Clinical Research; Comprehensive Health Care; Data; Databases; Development; Development Plans; Diagnosis; Disease; Effectiveness; Emergency department visit; Environment; Failure; Family; Funding; Future; Goals; Health Sciences; Health Services Research; Healthcare Systems; Hospitals; Intensive Care Units; Intervention; Interview; Knowledge; Life Experience; Lung; Malignant Neoplasms; Malignant neoplasm of lung; Measures; Medical center; Medicare; Methodological Studies; Methods; Minority; Mission; Modeling; NCI Scholars Program; National Cancer Institute; National Cancer Policy Board; Oncologist; Oregon; Outcome; Outpatients; Palliative Care; Patient Care; Patient-Focused Outcomes; Patients; Perception; Play; Population; Principal Investigator; Process; Provider; Qualitative Methods; Quality of Care; Quality of life; Research; Research Institute; Research Personnel; Research Support; Role; Sample Size; Specialist; Symptoms; System; Terminal Disease; Testing; Time; Toxic effect; Translational Research; United States; Universities; Variant; Veterans; Woman; Work; cancer care; cancer therapy; care delivery; career; career development; clinical practice; cohort; end of life; evidence base; experience; health care service utilization; improved; improved outcome; member; men; model development; mortality; neoplasm registry; patient population; physical symptom; psychological symptom; public health relevance; research and development; satisfaction; skill acquisition; symptom management; trial design; uptake

 DESCRIPTION (provided by applicant): This proposal will determine the impact of specialist palliative care on patient-centered outcomes and the quality of cancer care among advanced stage lung cancer patients. In addition, barriers and facilitators to integration in clinical practce will be explored. Specialist palliative care decreases patients' symptom burden and improves quality of life, but it is underutilized in clinical practice. The National Cancer Policy Board has defined poor-quality cancer care as when "practices of known effectiveness are being underutilized". Important knowledge gaps in current palliative care research contribute to this underutilization. The central hypothesis is that early, integrated specialist palliative care improves outcomes and the quality of cancer care among advanced stage lung cancer patients. In a mixed-methods approach, the association between palliative care referral and healthcare utilization and patient mortality will be determined. For the first time, variations in the processs of palliative care and their association with variations in the quality of care will be determined. Providers' perceptions of barriers and facilitators to integration with usual lung cancer care will be explored. All of these studies will be conducted in the national Veterans Affairs healthcare system utilizing a robust cancer registry and comprehensive patient care databases. The results from this proposal will inform the development of an effective palliative care model for implementation in healthcare systems. This model is expected to be applicable to integrated healthcare systems and may eventually be tested in other advanced cancer patient populations. The rationale that underlies the proposed research is that it has the potential to diminish factors that have decreased uptake of palliative care and substantially impact the lung cancer treatment paradigm. This proposal has significant potential to identify interventions that could improve care delivery, enhance end- of-life experiences, and promote greater utilization of palliative care in clinical practice. This proposal is relevant to the mission of the National Cancer Institute to support research concerned with the treatment of cancer and the continuing care of patients and their families. This research is one component of the principal investigator's K07 career development plan that demonstrates a logical scientific progression towards research independence with the ultimate goal of obtaining R-level funding by the end of the award period. A detailed plan for scientific skill development and obtaining proficiency as a mixed-methods researcher are included in this proposal. Lending evidence to the feasibility of this proposal is the supportive research environments at Oregon Health and Science University and the Portland Veterans Affairs Medical Center. Research progress and career development will be overseen by a select group of senior investigators, and supported by the Health Services Research & Development center and the Oregon Clinical and Translational Research Institute Scholar's Program for early career investigators.

 描述（由适用提供）：该提案将确定专业姑息治疗对以患者为中心的结果以及晚期肺癌患者中癌症护理质量的影响。此外，还将探讨临床实践中整合的障碍和促进者。专业姑息治疗可减少患者的症状伯恩伯恩（Burnen）并改善了生活质量，但在临床实践中未充分利用。国家癌症政策委员会有 当“已知有效性的实践未被充分利用”时，定义的质量质量不佳的癌症护理。当前姑息治疗研究对这一基础的重要知识差距。中心假设是，早期的综合专家姑息治疗改善了晚期肺癌患者的结局和癌症护理的质量。在混合方法的方法中，将确定姑息治疗转诊与医疗保健利用与患者死亡率之间的关联。将首次确定姑息治疗过程中的变化及其与护理质量差异的关联。 提供者对与通常的肺癌护理融合的障碍和促进者的看法将 被探索。所有这些研究将在国家退伍军人事务医疗系统中进行，利用强大的癌症注册表和全面的患者护理数据库进行。该提案的结果将为开发有效的姑息治疗模型，以实施医疗保健系统。预计该模型将适用于综合医疗保健系统，并最终可能在其他晚期癌症患者人群中进行测试。提案研究基础的基本原理是它有可能减少因素 这改善了姑息治疗的摄取并显着影响肺癌治疗范例。该提案具有巨大的潜力，可以确定可以改善护理服务，增强寿命末经历并促进姑息治疗的更大利用的干预措施 在临床实践中。该建议与国家癌症研究所的使命有关，以支持有关癌症治疗以及患者及其家人的持续护理的研究。这项研究是主要研究者K07职业发展计划的组成部分，该计划表明了对研究独立性的逻辑科学进步，其最终目标是在颁奖典礼期结束之前获得R级资助。该提案中包括了一个科学技能发展和获得混合方法研究人员熟练程度的详细计划。俄勒冈州健康与科学大学和波特兰退伍军人事务医学中心的支持研究环境是为此提出的可行性提供证据。研究进度和职业发展将由精选的高级研究人员组成，并得到卫生服务研究与发展中心以及俄勒冈州临床和转化研究所学者的早期职业研究人员计划的支持。