ICU Triage Decisions for Elders with End Stage Cancer: the Role of Patient Race

重症监护病房 (ICU) 对晚期癌症老年人的分诊决策：患者种族的作用

基本信息

批准号：
7799225
负责人：
AMBER E BARNATO
金额：
$ 13.43万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-04-01 至 2013-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7799225
关键词：
Admission activity Affective American Beds Behavior Belief Caucasoid Race Clinical Communication Critical Illness Decision Making Diagnosis Diagnostic Neoplasm Staging Discrimination Disseminated Malignant Neoplasm Elderly Event Family Future Goals Home environment Hospitals Hypoxia Individual Intensive Care Interview Life Malignant Neoplasms Mediating Medical Patient Preferences Patients Performance Physicians Pilot Projects Prejudice Privacy Probability Process Provider Public Health Race Recommendation Role Services Simulate Source Stereotyping Testing Time Triage Uncertainty Variant Work base communication behavior design end of life heuristics human subject protection improved in vivo outcome forecast patient oriented preference psychosocial public health relevance racial difference research study simulation success therapy design

项目摘要

DESCRIPTION (provided by applicant): One in five Americans die using intensive care (ICU) services despite a dominant cultural preference for dying at home. Blacks, especially those with cancer, are more likely to die in an ICU than whites, despite the fact that the majority of black elders have a preference against aggressive end-of-life treatment. For patients with end-stage cancer, seeking or deferring ICU admission is a critical single-event decision. While there is some evidence that blacks may be more likely to prefer aggressive life-sustaining treatment than whites, race-based differences in communication around end-of-life ICU use likely also contribute to existing disparities. Previous studies of physician decision making for common medical conditions have demonstrated race-based differences in diagnosis and treatment, ranging from overt prejudice, stereotyping and discrimination to the application of rules of conditional probability in the context of uncertainty. The goal of the proposed study is to enhance understanding of decision-making processes that impact end-of-life ICU use and factors which contribute to existing racial disparities in end-of-life ICU use. Our three specific aims are: 1) To test the effect of patient race on physician decisions to recommend ICU admission for a patient with end-stage cancer using high-fidelity simulation. 2) To test whether and how patient-provider communication mediates the effect of patient race on physician ICU admission decisions using qualitative content analysis of simulation encounters. 3) To explore the causes of race-based differences in ICU admission decision-making. A better understanding of physicians' decision-making processes and how they may contribute to a mismatch between patient preferences and end-of-life treatment could be used to design interventions to improve physician behavior. Public Health Relevance: The relevance of the proposed project to public health derives from a better understanding of how physicians contribute to racial variations in intensive care use at the end of life. The proposed project will be a success if can document differences in treatment decisions for black versus white simulated patients and generate hypotheses explaining these observed differences. Future work might include testing these hypotheses and developing educational modules for physicians aimed at improving their ability to make patient-centered decisions for critically ill patients with end-stage cancer.

描述（由申请人提供）：尽管人们普遍倾向于在家中去世，但五分之一的美国人在重症监护 (ICU) 服务中死亡。黑人，尤其是患有癌症的黑人，比白人更有可能在重症监护病房中死亡，尽管大多数黑人老年人都倾向于反对积极的临终治疗。对于晚期癌症患者来说，寻求或推迟入住 ICU 是一个关键的单一事件决定。虽然有一些证据表明黑人可能比白人更喜欢积极的维持生命治疗，但围绕临终 ICU 使用的沟通方面基于种族的差异也可能导致现有的差异。先前对医生针对常见医疗状况做出决策的研究表明，在诊断和治疗方面存在基于种族的差异，从明显的偏见、刻板印象和歧视到在不确定性背景下条件概率规则的应用。拟议研究的目的是加深对影响临终 ICU 使用的决策过程以及导致临终 ICU 使用中现有种族差异的因素的理解。我们的三个具体目标是：1) 使用高保真模拟来测试患者种族对医生推荐终末期癌症患者入住 ICU 的决定的影响。 2) 使用模拟遭遇的定性内容分析来测试医患沟通是否以及如何调节患者种族对医生 ICU 入院决策的影响。 3）探讨ICU入院决策中种族差异的原因。更好地了解医生的决策过程以及它们如何导致患者偏好和临终治疗之间的不匹配，可以用来设计干预措施来改善医生的行为。公共卫生相关性：拟议项目与公共卫生的相关性源于对医生如何影响临终重症监护使用的种族差异的更好理解。如果能够记录黑人与白人模拟患者治疗决策的差异，并生成解释这些观察到的差异的假设，那么拟议的项目将取得成功。未来的工作可能包括测试这些假设并为医生开发教育模块，旨在提高他们为患有末期癌症的危重患者做出以患者为中心的决策的能力。

项目成果

期刊论文数量（7）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Key Physician Behaviors that Predict Prudent, Preference Concordant Decisions at the End of Life.

预测临终时谨慎、偏好一致决策的关键医生行为。

DOI：
发表时间：
2021-10
期刊：
影响因子：
0
作者：
Morales, Andre;Murphy, Alan;Fanning, Joseph B;Gao, Shasha;Schultz, Kevan;Hall, Daniel E;Barnato, Amber
通讯作者：
Barnato, Amber

Physicians' decision-making roles for an acutely unstable critically and terminally ill patient.

医生对极度不稳定的危重和绝症患者的决策作用。

DOI：
发表时间：
2013-06
期刊：
影响因子：
8.8
作者：
Uy, Jamie;White, Douglas B;Mohan, Deepika;Arnold, Robert M;Barnato, Amber E
通讯作者：
Barnato, Amber E

Differences in Physicians' Verbal and Nonverbal Communication With Black and White Patients at the End of Life.

医生与临终黑人和白人患者的言语和非言语交流的差异。

DOI：
发表时间：
2016-01
期刊：
影响因子：
4.7
作者：
Elliott, Andrea M;Alexander, Stewart C;Mescher, Craig A;Mohan, Deepika;Barnato, Amber E
通讯作者：
Barnato, Amber E

Prudence in end-of-life decision making: A virtue-based analysis of physician communication with patients and surrogates.

临终决策的审慎：对医生与患者和代理人沟通的基于美德的分析。

DOI：
发表时间：
2022-12
期刊：
影响因子：
0
作者：
Murphy, Alan C;Schultz, Kevan C;Gao, ShaSha;Morales, Andre M;Barnato, Amber E;Fanning, Joseph B;Hall, Daniel E
通讯作者：
Hall, Daniel E

A randomized trial of the effect of patient race on physicians' intensive care unit and life-sustaining treatment decisions for an acutely unstable elder with end-stage cancer.

一项随机试验，研究患者种族对医生重症监护病房和患有末期癌症的急性不稳定老年人的生命维持治疗决策的影响。