A Novel Approach to Elucidate Mechanisms for Disparity in Cancer Pain Outcomes

阐明癌症疼痛结果差异机制的新方法

• 批准号: 7811759
• 负责人: Salimah H. Meghani
• 金额: $ 44.86万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-25 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7811759
• 关键词: Absence of pain sensation; Accounting; Adherence; Advance Care Planning; African American; American; Analgesics; Area; Attitude; Caring; Characteristics; Classification; Clinical; Clinical Research; Complex; Computer Literacy; Computers; Data; Decision Making; Disease; Employee; Engineering; Enrollment; Foundations; Guidelines; Health; Healthcare; Individual; Inequality; Institute of Medicine (U.S.); Intervention; Knowledge; Link; Literature; Marketing; Measures; Medical; Methodology; Methods; Minority; Mission; Occupations; Outcome; Outcome Study; Pain; Palliative Care; Participant; Patient Preferences; Patients; Pennsylvania; Perception; Physicians; Positioning Attribute; Process; Prospective Studies; Provider; Psyche structure; Psychology; Public Health; Recommendation; Recovery; Relative (related person); Reporting; Research; Research Design; Risk; Risk Adjustment; Role; Science; Source; Subgroup; Surveys; System; Techniques; Technology; Testing; Time; Treatment outcome; Uncertainty; United States National Institutes of Health; Universities; Utility Theories; Variant; base; cancer pain; compliance behavior; design; end of life; end of life care; heuristics; hospice environment; improved; interest; lens; medication compliance; novel; novel strategies; patient oriented; preference; prospective; racial and ethnic; racial and ethnic disparities; stability testing; stem; symptom management

DESCRIPTION (provided by applicant): Title: A Novel Approach to Elucidate Mechanisms for Disparity in Cancer Pain Outcomes This study responds to the broad challenge area (04) Clinical Research, and the specific challenge topic, 04- NR-102* Methods to Enhance Palliative Care and End-of-Life Research. Racial/ethnic disparities in palliative care outcomes are increasingly reported in the literature including inequalities in hospice enrollment, differential preference for high technology care at the end-of-life, and disparities in symptom management outcomes. Choice-Based Conjoint Analysis (CBC) is promising valuation technique grounded in the Random Utility Theory and mathematical psychology to understand what people value and what really drives them to choose one set of alternatives over another when faced with competing choices. While the technique is well established in the marketing arena and consumer research, the application of CBC in the healthcare field is relatively new, although there is growing interest in this methodology. CBC may enhance our understanding of the mechanisms underlying racial/ethnic disparities in palliative care outcomes. This potentially important application of CBC in studying sources of disparities has not been exploited in palliative care research. Using cancer pain treatment disparities as an exemplar, we propose to investigate the utility and predictive validity of CBC in identifying mechanisms underlying racial disparities in cancer pain treatment outcomes. Accumulating evidence suggests that African Americans are less likely to receive guideline recommended analgesia despite risk-adjustment and even among those insured at similar levels as non-minority individuals. The system and provider-level factors have not been able to fully explicate the mechanisms contributing to these disparities. Patient-level factors, including patients' attitudes and preferences towards pain treatment, that may also account for clinical disparities may hold the answer. Using CBC, this prospective study offers a unique conceptual, methodological, and analytical lens to understanding what value patients place in analgesic treatment for cancer pain and link this unique information to a comprehensive set of socio-demographic, illness and pain-related variables. Predictive ability of a measure is a critical determinant of its validity; the proposed study also assesses the predictive validity of CBC by investigating the relationship between stated preference (CBC utilities) and actual adherence to prescription analgesia for cancer pain. Moreover, the research carefully incorporates an analysis of racial disparities across aims to further understanding of clinical differences in cancer pain outcomes. The scientific approach identified in this study will lay the foundation for developing patient-centered interventions that incorporate patient preferences into complex medical decision-making in improving cancer pain outcomes and by extension outcomes in other symptom management settings. At University of Pennsylvania, we are well-positioned to quickly expand our research capacity and employee- base benefitting the science and the overall economy. In keeping with the American Recovery and Reinvestment Act, the current project will create 7 new jobs (1 full-time, 4 part-time, and 2 per-diem). Healthcare often involves making competing choices under risks and uncertainties. This research uses a novel technique, Choice-based Conjoint Analysis (CBC), to understand if African Americans and Whites with cancer pain use different mental trade-offs in arriving at pain treatment decisions; have differential preferences for cancer pain treatment; and how this may relate to their adherence to pain medications for cancer pain. CBC method has implications for generating knowledge about how subgroups of patients make decisions regarding choices such as symptom management, advanced care planning, hospice enrollment, or the use of technologically advanced end-of-life care. Findings will help identify targets sensitive to tailored, patient-centered interventions in improving equity in palliative care outcomes.

描述（由申请人提供）：标题：一种阐明癌症疼痛差异机制的新方法，这项研究对广泛的挑战领域（04）临床研究做出了反应，以及特定的挑战主题，04- NR-102*增强姑息治疗和寿命最终研究的方法。 在文献中越来越多地报道了姑息治疗成果的种族/种族差异，包括临终关怀的不平等，在临终关怀终止时对高科技护理的差异偏好以及症状管理结果的差异。基于选择的联合分析（CBC）是基于随机效用理论和数学心理学的有希望的估值技术，以了解人们的价值以及真正驱使他们真正驱使他们在面对竞争选择时选择一套替代方案。尽管该技术在营销领域和消费者研究中已建立，但CBC在医疗保健领域的应用相对较新，尽管对这种方法的兴趣越来越大。 CBC可能会增强我们对姑息治疗结果中种族/种族差异的机制的理解。 CBC在研究差异来源中的这种潜在的重要应用并未在姑息治疗研究中得到利用。我们建议将癌症疼痛治疗差异作为典范，我们建议研究CBC在识别癌症疼痛治疗结果中种族差异的机制方面的效用和预测有效性。积累的证据表明，尽管有风险调整，甚至在与非少数人相似的水平上，非洲裔美国人不太可能接受建议的镇痛指南。系统和提供商级别的因素无法完全阐明导致这些差异的机制。患者水平的因素，包括患者的态度和对疼痛治疗的偏好，这也可能解释了临床差异。这项前瞻性研究使用CBC提供了一项独特的概念，方法论和分析镜头，以了解哪些有价值的患者在止痛治疗中对癌症疼痛进行了哪些值，并将这些独特信息与一组全面的社会人口统计学，疾病，疾病和与疼痛相关的变量联系起来。度量的预测能力是其有效性的关键决定因素。拟议的研究还通过研究偏好（CBC实用程序）和对处方镇痛的实际遵守癌症疼痛之间的关系来评估CBC的预测有效性。此外，该研究仔细地结合了对种族差异的分析，目的是进一步了解癌症疼痛结果的临床差异。这项研究中确定的科学方法将为开发以患者为中心的干预措施奠定基础，这些干预措施将患者的偏好纳入复杂的医疗决策，以改善癌症疼痛结果以及其他症状管理环境中的扩展结果。在宾夕法尼亚大学，我们有充分的位置，可以迅速扩大我们的研究能力，并使员工受益于科学和整体经济。为了符合《美国恢复和再投资法》，当前的项目将创造7个新工作（1个全职，4个兼职和2个Diem）。医疗保健通常涉及在风险和不确定性下做出竞争选择。这项研究使用一种新型的技术，基于选择的联网分析（CBC）来了解非裔美国人和患有癌症疼痛的白人是否在做出疼痛治疗决策时使用不同的精神折衷。对癌症疼痛治疗有不同的偏好；以及这与他们遵守止痛药的癌症疼痛有关。 CBC方法具有有关如何在症状管理，高级护理计划，临终关怀入学或使用技术先进的寿险终止护理等选择的决定方面做出决定的知识的意义。调查结果将有助于确定对量身定制的以患者为中心的干预措施敏感的目标，以改善姑息治疗结果的股权。