Pilot Trial of a "Divine Intervention" to Improve End-of-Life Cancer Care for Black Patients

改善黑人癌症临终护理的“神圣干预”试点试验

• 批准号: 10747114
• 负责人: Paul K Maciejewski
• 金额: $ 28.63万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-21 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10747114
• 关键词: Address; Advance Care Planning; Advance Directives; Advanced Malignant Neoplasm; Affect; African American; Agreement; Ambulatory Care; Belief; Black race; Cancer Patient; Caring; Cessation of life; Chaplain; Clinic; Comparison arm; Data; Decision Making; Distant; Distress; Do Not Resuscitate Order; Dose; Eligibility Determination; Failure; Healthcare; Individual; Inpatients; Intensive Care; Intervention; Malignant Neoplasms; Medical; Oncology; Outcome; Outpatients; Palliative Care; Patient-Focused Outcomes; Patients; Personal Satisfaction; Prayers; Provider; Quality of life; Randomized; Randomized, Controlled Trials; Readiness; Religion; Religion and Spirituality; Reporting; Services; Spiritual care; Spirituality; System; Terminal Disease; Visit; Work; arm; black patient; black/white disparity; cancer care; care outcomes; commune; coping; end of life; end of life care; experience; improved; novel; oncology service; oncology trial; pilot trial; post intervention; primary outcome; skills

Project Summary Most advanced cancer patients report that religiousness and/or spirituality (R/S) are important to them, yet most also say that the medical system has not met their R/S needs. Support of dying patients' R/S needs may prove especially beneficial to those who are religious, including African American (hereafter, “black”) patients who often rely heavily on religion to cope with cancer. Healthcare chaplains work within medical systems to provide R/S care. Among advanced cancer patients, visits with healthcare chaplains are associated with patients' peaceful acceptance of terminal illness, which is associated with higher rates of advance care planning (ACP), which in turn has proved an effective way to enhance a dying patient's quality of life and receipt of value-concordant end-of-life (EoL) care. Additionally, preliminary data suggest that healthcare chaplain visits are associated with higher rates of completing do-not-resuscitate (DNR) orders among black advanced cancer patients. At present, healthcare chaplains work predominantly in inpatient settings. Thus, advanced cancer patients in outpatient settings have not benefited from the many positive effects of healthcare chaplaincy, including having unmet spiritual needs addressed and the benefits of incorporating spiritual care into EoL decision-making and the cancer care experience. To date, there has not been a randomized controlled trial (RCT) of effects of early integration of healthcare chaplain-led spiritual care on EoL cancer care. We propose here to determine the feasibility of conducting such a trial and to explore potential effects of healthcare chaplain-led spiritual care on spiritual well-being and readiness to engage in ACP among black advanced cancer patients in outpatient settings. Specifically, we propose: Aim #1: Will determine the feasibility of conducting an RCT of effects of early integration of healthcare chaplain-led spiritual care into outpatient oncology care on EoL care. Aim #2: Will explore potential effects of healthcare chaplain-led spiritual care on spiritual well-being and ACP among black advanced cancer patients in outpatient settings. Aim #3: Will explore potential mechanisms by which healthcare chaplain-led spiritual care in outpatient settings affect black advanced cancer patients' EoL care outcomes. Impact: Results will provide evidence of the feasibility of conducting an RCT of the effects of early outpatient (in advance of a terminal inpatient) healthcare chaplain-led spiritual care on spiritual well-being and ACP among black advanced cancer patients. Integration of healthcare chaplain-led spiritual care into outpatient oncology services for advanced cancer patients may be an impactful, scalable way to improve the EoL cancer care experience among black patients with advanced cancer.

项目概要 大多数晚期癌症患者表示，宗教信仰和/或灵性 (R/S) 对他们来说很重要，但 大多数人还表示，医疗系统尚未满足他们的 R/S 需求，可能会支持临终患者的 R/S 需求。 事实证明对宗教人士特别有益，包括非裔美国人（以下简称“黑人”）患者 他们经常严重依赖宗教来应对癌症。 在晚期癌症患者中，看护牧师与提供 R/S 护理相关。 患者平静地接受绝症，这与较高的预先护理率有关 计划（ACP），这反过来又被证明是提高临终患者的生活质量和 接受价值一致的临终 (EoL) 护理。 牧师探访与黑人完成不复苏 (DNR) 命令的比率较高相关 目前，医疗牧师主要在住院环境中工作。 门诊晚期癌症患者并未从医疗保健的许多积极影响中受益 牧师，包括解决未满足的精神需求以及纳入精神护理的好处 迄今为止，还没有对 EoL 决策和癌症护理经验进行随机研究。 对照试验 (RCT)，研究早期整合医疗牧师主导的精神护理对临终癌症护理的影响。 我们在此建议确定进行此类试验的可行性并探讨其潜在影响 由医疗牧师领导的精神护理，关注黑人的精神健康和参与 ACP 的准备情况 具体而言，我们建议： 目标 1：将确定门诊环境中的晚期癌症患者。 进行随机对照试验，研究早期将医疗牧师主导的精神护理纳入 门诊肿瘤护理对 EoL 护理的影响 目标 2：将探索医疗牧师主导的潜在影响。 精神护理对门诊黑人晚期癌症患者精神健康和 ACP 的影响。 目标#3：将探索医疗牧师主导的门诊精神护理的潜在机制 设置影响黑人晚期癌症患者的临终护理结果：结果将提供证据。 对早期门诊患者（在临终住院患者之前）的影响进行随机对照试验的可行性 由医疗牧师主导的对黑人晚期癌症患者的精神健康和 ACP 的精神护理。 将医疗牧师主导的精神护理纳入晚期癌症的门诊肿瘤学服务 患者可能是改善黑人患者临终癌症护理体验的一种有效、可扩展的方法 患有晚期癌症。