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: 7938668
• 负责人: Salimah H. Meghani
• 金额: $ 39.73万
• 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 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7938668
• 关键词: Absence of pain sensation; Accounting; Adherence; Advance Care Planning; African American; American; Analgesics; Area; Attitude; Caring; Characteristics; 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：阐明癌症疼痛结果差异机制的新方法 这项研究响应了广泛的挑战领域 (04) 临床研究，以及具体的挑战主题 04- NR-102* 增强方法姑息治疗和临终研究。 文献中越来越多地报道了姑息治疗结果中的种族/民族差异，包括临终关怀登记的不平等、临终时对高科技护理的不同偏好以及症状管理结果的差异。基于选择的联合分析 (CBC) 是一种基于随机效用理论和数学心理学的有前途的估值技术，可以了解人们看重什么，以及在面临竞争选择时真正促使他们选择一组替代方案而不是另一组替代方案的原因。虽然该技术在营销领域和消费者研究中已经很成熟，但 CBC 在医疗保健领域的应用相对较新，尽管人们对这种方法越来越感兴趣。 CBC 可能会增强我们对姑息治疗结果中种族/民族差异背后机制的理解。 CBC 在研究差异来源方面的潜在重要应用尚未在姑息治疗研究中得到利用。以癌痛治疗差异为例，我们建议研究 CBC 在确定癌痛治疗结果种族差异背后的机制方面的实用性和预测有效性。越来越多的证据表明，尽管进行了风险调整，非裔美国人接受指南推荐的镇痛治疗的可能性较小，甚至在与非少数族裔投保水平相似的人中也是如此。系统和提供商层面的因素还无法完全解释造成这些差异的机制。患者层面的因素，包括患者对疼痛治疗的态度和偏好，也可能解释临床差异，这可能就是答案。这项前瞻性研究利用 CBC，提供了一个独特的概念、方法和分析视角，以了解患者对癌症疼痛镇痛治疗的重视程度，并将这一独特信息与一套全面的社会人口、疾病和疼痛相关变量联系起来。一项措施的预测能力是其有效性的关键决定因素；拟议的研究还通过调查陈述偏好（CBC 效用）与实际遵守癌症疼痛处方镇痛之间的关系来评估 CBC 的预测有效性。此外，该研究仔细纳入了对不同种族差异的分析，旨在进一步了解癌症疼痛结果的临床差异。本研究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中，以改善癌症疼痛的结果，并通过扩展其他症状管理环境的结果。在宾夕法尼亚大学，我们处于有利位置，可以快速扩大我们的研究能力和员工基础，从而造福于科学和整体经济。根据《美国复苏和再投资法案》，当前项目将创造 7 个新就业岗位（1 个全职、4 个兼职和 2 个每日津贴）。医疗保健通常涉及在风险和不确定性的情况下做出竞争性选择。这项研究使用了一种新技术，即基于选择的联合分析（CBC），来了解患有癌症疼痛的非裔美国人和白人在做出疼痛治疗决定时是否使用不同的心理权衡；对癌痛治疗有不同的偏好；以及这与他们坚持使用治疗癌症疼痛的止痛药物有何关系。 CBC 方法对于生成有关患者亚组如何做出有关症状管理、高级护理计划、临终关怀登记或使用技术先进的临终护理等选择的决策的知识具有重要意义。研究结果将有助于确定对定制的、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公平性。