Black-White Differences in Advanced Cancer Communication, Acceptance, and Care

晚期癌症沟通、接受和护理方面的黑白差异

• 批准号: 8135136
• 负责人: Holly Gwen Prigerson
• 金额: $ 3.17万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-04-01 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8135136
• 关键词: Achievement; Address; Advance Care Planning; Advanced Malignant Neoplasm; Affect; Age; Be++ element; Benefits and Risks; Beryllium; Boston; Cancer Patient; Caregivers; Caring; Clinic Visits; Clinical; Cognitive; Communication; Conscious; Cultural Diversity; Data; Data Set; Decision Making; Disclosure; Do Not Resuscitate Order; Enrollment; Environmental air flow; Family; Family member; Friends; Gender; Genetic Transcription; Goals; Health Communication; Healthcare; Healthcare Systems; Intensive Care; Intervention; Interview; Knowledge; Life; Life Expectancy; Life Extension; Malignant Neoplasms; Mediating; Mediation; Medical; Mentally Ill Persons; Modeling; Not Hispanic or Latino; Nurse Practitioners; Oncologist; Outcome; Palliative Care; Parents; Patient Preferences; Patients; Physicians; Procedures; Process; Provider; Psychosocial Influences; Public Health; Quality of life; Recruitment Activity; Relative (related person); Reporting; Research; Research Infrastructure; Resources; Resuscitation; Role; Sampling; Services; Site; Social support; Spirituality; Stage at Diagnosis; Surveys; Tape Recording; Terminal Disease; Terminally Ill; Testing; Treatment outcome; Visit; Work; base; coping; cost; cultural competence; design; end of life; end of life care; end-of-life communication; health literacy; hospice environment; improved; information gathering; meetings; oncology; outcome forecast; preference; prevent; prognostic; public health relevance; quality of death; therapy development

DESCRIPTION (provided by applicant): Results from our "Quality of Death: Ethnic and Psychosocial Influences" ["Coping with Cancer" (CwC)] study demonstrate that at the end-of-life (EOL) black, compared with white, cancer patients receive more intensive, expensive, non-curative care (e.g., higher rates of ICU stays, ventilation, and resuscitation). We find that intensive care does not prolong life, but does impair quality of life. CwC results also reveal that black, compared to white, advanced cancer patients are less likely to consider themselves terminally ill, are more likely to prefer life-prolonging treatments, and are less likely to engage in advance care planning. In the full CwC sample, EOL discussions with physicians are associated with greater patient acceptance of terminal illness, a preference for comfort care over life-extension, fewer life-prolonging procedures, more palliative care, and receipt of care consistent with patient wishes. However, among black CwC patients, EOL discussions are not associated with greater acceptance of terminal illness, EOL care received, or EOL care consistent with patient wishes. This raises the question of how communication between oncology providers and patients may differ by whether the patient is black or white, and how these differences contribute to disparities in EOL care. For this CwC renewal, we apply the Structural Influence Model of Health Communication to determine how EOL communication processes (e.g., oncology provider's prognostic disclosure) vary depending on whether the patient is black or white. It posits that the effects of communication processes on the achievement of communication goals (e.g., acceptance of illness) will be weaker for black compared with white patients. Likewise, it posits that the effects of communication goals on EOL outcomes (i.e., intensive/palliative care received, receipt of care consistent with patient preferences, and quality of life) will be weaker in black compared with white patients. We propose to enroll 400 advanced cancer patients (200 black and 200 white patients) with a less than 6 month life-expectancy. Patients and their primary family/friend caregiver will be recruited from sites in Boston (MA), Dallas (TX), and Richmond (VA). At baseline, enrolled patients will complete a brief pre-clinic visit survey. The clinic visit will be audio-taped and patients, caregivers and the patient's primary oncology provider will be interviewed after the visit. Patients will be interviewed before and after their clinic visit one month later. That clinic visit will also be audio-taped. Medical care received in the last month of life will be documented via chart extraction. The caregiver interviewed at baseline will be interviewed one month post-loss about the health care the patient received in the final month and about the patient's mental and physical status in the last week of life. Results will indicate which communication processes and communication goals are promising targets for interventions to reduce black-white disparities in EOL care and improve quality of life for all cancer patients. PUBLIC HEALTH RELEVANCE: The disproportionately high rates of intensive, non-curative, burdensome care received by black relative to white advanced cancer patients at the end of life (EOL) has been recognized as a serious public health concern. This study will examine how EOL communications between advanced cancer patients, caregivers, and oncology providers contribute to black-white differences in: a) acceptance of terminal illness, b) knowledge of risks/benefits EOL treatment outcomes, and c) advance care planning, and how these "communication goals" affect the rates at which patients receive: a) intensive, life-prolonging care b) palliative care, c) care consistent with patient preferences, and d) the patient's quality of life at the EOL. Results will inform the development of interventions to promote the cultural-competence of EOL communications to enhance informed decision-making, promote patient quality of life, and reduce disparities in EOL care.

描述（由申请人提供）：我们的“死亡质量：种族和社会心理影响”的结果[“与癌症的应对”（CWC）]研究表明，与白色的癌症患者相比，在生命终止（EOL）黑色（EOL）黑色（EOL），获得更昂贵，更昂贵的，非持续性的护理（例如，ICU的较高的ICU持续，通风率较高，以及较高的ICU，通风和依据）。我们发现重症监护并不能延长寿命，而是会损害生活质量。 CWC的结果还表明，与白人，晚期癌症患者相比，黑人不太可能将自己视为绝症，更可能更喜欢养生治疗，并且不太可能参与预先护理计划。在完整的CWC样本中，与医生的EOL讨论与患者更加接受绝症有关，偏爱舒适护理而不是延长生命，较少的寿命程序，更多的姑息治疗以及与患者愿望一致的护理。但是，在黑色CWC患者中，EOL讨论与对患者意愿一致的最终疾病，EOL护理或EOL护理的接受无关。这就提出了一个问题，即肿瘤学提供者与患者之间的沟通如何因患者是黑人还是白人的差异，以及这些差异如何导致EOL护理的差异。对于此CWC续订，我们应用健康沟通的结构影响模型来确定EOL通信过程（例如，肿瘤提供者的预后披露）如何取决于患者是黑人还是白色。它认为与白人患者相比，黑人的沟通过程对实现沟通目标的影响（例如，接受疾病）将较弱。同样，它认为与白人患者相比，黑人的沟通目标对EOL结果的影响（即接受的密集/姑息治疗，接受与患者偏好一致的护理以及与患者偏爱一致的护理的影响）将较弱。我们建议招募400名晚期癌症患者（200名黑人和200名白人患者），预期寿命不到6个月。患者及其主要家庭/朋友护理人员将从波士顿（MA），达拉斯（TX）和里士满（VA）的地点招募。在基线时，入学的患者将完成一项简短的临时访问调查。诊所的访问将是音频的，患者，护理人员和患者的主要肿瘤学提供者将在访问后接受采访。一个月后，将在他们的诊所就诊之前和之后接受采访。该诊所的访问也将是音频冠军。生命的最后一个月收到的医疗服务将通过图表提取记录。损坏后一个月，关于患者在最后一个月获得的医疗保健以及患者在生命的最后一周的心理和身体状况，将接受接受采访的护理人员。结果将表明哪些沟通过程和沟通目标是干预措施的有希望的目标，以减少EOL护理中的黑白差异并改善所有癌症患者的生活质量。 公共卫生相关性：黑人相对于生命末期（EOL）的白人相对于白人晚期癌症患者所接受的密集，非疗法，繁重的护理率不成比例的，已被认为是一个严重的公共健康问题。这项研究将研究高级癌症患者，护理人员和肿瘤学提供者之间如何促进黑白差异的差异：在EOL的生活。结果将为促进EOL通信的文化胜任的干预措施的发展提供信息，以增强明智的决策，促进患者的生活质量并减少EOL护理中的差异。