Determinants of Palliative Care Effectiveness for Patients with Metastatic Cancer

转移性癌症患者姑息治疗效果的决定因素

• 批准号: 10576889
• 负责人: May Hua
• 金额: $ 60.23万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-03 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10576889
• 关键词: Advanced Malignant Neoplasm; Affect; American Society of Clinical Oncology; Cancer Center; Cancer Hospital; Caring; Certification; Characteristics; Clinical; Collection; Consultations; Data; Data Set; Data Sources; Decision Making; Disseminated Malignant Neoplasm; Effectiveness; Electronics; Enrollment; Ensure; Goals; Growth; Guidelines; Heterogeneity; Hospitals; Institution; Intensive Care Units; Interview; Knowledge; Length; Life; Link; Malignant Neoplasms; Measures; Mediation; Medicare claim; Modeling; Morphologic artifacts; National Cancer Institute; Outcome; Outpatients; Palliative Care; Pathway interactions; Patient Care; Patient-Focused Outcomes; Patients; Persons; Physician Data Query; Policies; Population; Protocols documentation; Provider; Psychosocial Assessment and Care; Qualitative Research; Quality of Care; Quality of life; Race; Recommendation; Registries; Research; Research Methodology; Role; Site; Site Visit; Specialist; Targeted Research; Time; United States; Visit; Work; Writing; acute care; cancer care; care delivery; care systems; chemotherapy; cohort; cost; end of life; end of life care; future implementation; health care service utilization; hospice environment; hospital care; hospital readmission; improved; improved outcome; informant; insight; novel; preference; programs; symptom management; symptomatology

Project Summary Palliative care is an interdisciplinary model of care with the overarching goal of improving quality of life for patients with serious illness through symptom management, provision of psychosocial support, elicitation of preferences and aiding decision-making. Prior studies have demonstrated that specialist palliative care is associated with decreases in treatment intensity and improvements in quality of life, but have also suggested that existing heterogeneity among palliative care teams may be associated with variability in their effectiveness. Early integration of specialist palliative care for patients with advanced cancer has been recommended by the American Society of Clinical Oncology. However, as hospitals race to implement palliative care programs to meet these guidelines, there is little evidence to guide them as to which ingredients are necessary for effective care delivery. The proposed research will target this important knowledge gap by 1) quantifying the association between use of specialist palliative care and end-of-life quality metrics in cancer care, 2) examining whether differences in specialist palliative care implementation (as measured by key variables reflecting team attributes and operational characteristics) are associated with improvements in quality metrics and 3) using qualitative research methods to understand how programs operationalize care delivery within different hospital settings. This project will create and utilize a novel data source that combines nationwide patient and hospital-level data, detailed data on palliative care programs and valid information on receipt of specialist palliative care. Quantitative analyses of this unique dataset will be followed by in-depth site visits to six select palliative care programs; together, these data will be used to develop an actionable roadmap that may be used to refine existing palliative care programs and inform implementation of future programs to ensure effective delivery of palliative care for patients with cancer. This project represents an important advance in understanding the role of palliative care specialists in cancer care, as prior work has focused on whether specialist palliative care is associated with improved outcomes, while this work will focus identifying the conditions under which specialist palliative care may achieve improved outcomes.

项目摘要 姑息治疗是一种跨学科护理模型，具有改善生活质量的总体目标 通过症状管理患有严重疾病的患者，提供社会心理支持，引起 偏好和协助决策。先前的研究表明，专业姑息治疗是 与治疗强度的降低和生活质量改善有关，但也建议 姑息治疗团队中现有的异质性可能与其可变性有关 效力。早期针对晚期癌症患者的专业姑息治疗的早期整合是 由美国临床肿瘤学会推荐。但是，随着医院的实施 姑息治疗计划可以符合这些准则，几乎没有证据可以指导它们 对于有效的护理服务是必需的。拟议的研究将以1的目标为目标。 量化使用专业姑息治疗与癌症终止质量指标之间的关联 护理，2）检查专家姑息治疗实施的差异（按密钥衡量 反映团队属性和操作特征的变量）与质量的改善有关 指标和3）使用定性研究方法来了解计划如何运行护理交付 在不同的医院环境中。该项目将创建并利用组合的新型数据源 全国患者和医院级别的数据，姑息治疗计划的详细数据以及有关的有效信息 接收专业姑息治疗。该独特数据集的定量分析将随后深入站点 访问六个精选的姑息治疗计划；这些数据将一起用于开发可行的路线图 可以用来完善现有的姑息治疗计划，并告知未来计划的实施 确保为癌症患者有效提供姑息治疗。这个项目代表了一个重要的 在理解姑息治疗专家在癌症护理中的作用方面的进步，因为先前的工作着重于 专业姑息治疗是否与改善的结果有关，而这项工作将集中精力确定 专业姑息治疗可能提高结果的条件。