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.

项目摘要 大多数高级癌症患者报告说，宗教和/或灵性（R/S）对他们很重要，但是 大多数人还说，医疗系统尚未满足他们的R/S需求。支持垂死的患者的R/S需求可能 证明对包括非裔美国人（以下称为“黑色”）患者在内的宗教人士特别有益 他们经常严重依靠宗教来应对癌症。医疗保健牧师在医疗系统中起作用 提供R/S护理。在晚期癌症患者中，医疗保健牧师的访问与 患者对绝症的和平接受，这与较高的预先护理率有关 计划（ACP），这反过来证明是增强垂死患者的生活质量和的有效方法 收到价值结合生命终止（EOL）护理。此外，初步数据表明医疗保健 牧师的访问与黑色完成DO-NOT-NOT命令（DNR）的较高率有关 晚期癌症患者。目前，医疗保健牧师主要在住院环境中起作用。那， 在门诊环境中的高级癌症患者并未受益于医疗保健的许多积极影响 牧师，包括满足精神需求以及纳入精神护理的好处 进入EOL决策和癌症护理经验。迄今为止，还没有随机 医疗保健牧师主导的精神护理对EOL癌症护理的早期整合的影响试验（RCT）。 我们在这里建议确定进行此类试验的可行性，并探索 医疗保健牧师主导的精神护理对精神福祉和准备在黑人中参与ACP 在门诊环境中的晚期癌症患者。具体来说，我们建议：目标＃1：将确定 进行医疗保健牧师主导的精神护理的早期整合到纳入的可行性 在EOL护理方面的门诊肿瘤护理。 AIM＃2：将探索由医疗保健牧师主导的潜在影响 在门诊环境中，黑人晚期癌症患者的精神福祉和ACP的精神护理。 目的＃3：将探讨医疗保健牧师主导的门诊的潜在机制 设置会影响黑色晚期癌症患者的EOL护理结果。影响：结果将提供证据 进行早期门诊效应的RCT的可行性（在末端住院之前） 黑人晚期癌症患者的医疗保健牧师主导的精神健康和ACP的精神护理。 将医疗保健牧师主导的精神护理整合到高级癌症的门诊肿瘤服务中 患者可能是改善黑人患者EOL癌症护理经验的有影响力，可扩展的方法 患有晚期癌症。