Determinants of Palliative Care Effectiveness for Patients with Metastatic Cancer

转移性癌症患者姑息治疗效果的决定因素

• 批准号: 10576889
• 负责人: May Hua
• 金额: $ 60.23万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-03 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10576889
• 关键词: Advanced Malignant Neoplasm; Affect; American Society of Clinical Oncology; Cancer Center; Cancer Hospital; Caring; Certification; Characteristics; Clinical; Collection; Consultations; Data; Data Set; Data Sources; Decision Making; Disseminated Malignant Neoplasm; Effectiveness; Electronics; Enrollment; Ensure; Goals; Growth; Guidelines; Heterogeneity; Hospitals; Institution; Intensive Care Units; Interview; Knowledge; Length; Life; Link; Malignant Neoplasms; Measures; Mediation; Medicare claim; Modeling; Morphologic artifacts; National Cancer Institute; Outcome; Outpatients; Palliative Care; Pathway interactions; Patient Care; Patient-Focused Outcomes; Patients; Persons; Physician Data Query; Policies; Population; Protocols documentation; Provider; Psychosocial Assessment and Care; Qualitative Research; Quality of Care; Quality of life; Race; Recommendation; Registries; Research; Research Methodology; Role; Site; Site Visit; Specialist; Targeted Research; Time; United States; Visit; Work; Writing; acute care; cancer care; care delivery; care systems; chemotherapy; cohort; cost; end of life; end of life care; future implementation; health care service utilization; hospice environment; hospital care; hospital readmission; improved; improved outcome; informant; insight; novel; preference; programs; symptom management; symptomatology

Project Summary Palliative care is an interdisciplinary model of care with the overarching goal of improving quality of life for patients with serious illness through symptom management, provision of psychosocial support, elicitation of preferences and aiding decision-making. Prior studies have demonstrated that specialist palliative care is associated with decreases in treatment intensity and improvements in quality of life, but have also suggested that existing heterogeneity among palliative care teams may be associated with variability in their effectiveness. Early integration of specialist palliative care for patients with advanced cancer has been recommended by the American Society of Clinical Oncology. However, as hospitals race to implement palliative care programs to meet these guidelines, there is little evidence to guide them as to which ingredients are necessary for effective care delivery. The proposed research will target this important knowledge gap by 1) quantifying the association between use of specialist palliative care and end-of-life quality metrics in cancer care, 2) examining whether differences in specialist palliative care implementation (as measured by key variables reflecting team attributes and operational characteristics) are associated with improvements in quality metrics and 3) using qualitative research methods to understand how programs operationalize care delivery within different hospital settings. This project will create and utilize a novel data source that combines nationwide patient and hospital-level data, detailed data on palliative care programs and valid information on receipt of specialist palliative care. Quantitative analyses of this unique dataset will be followed by in-depth site visits to six select palliative care programs; together, these data will be used to develop an actionable roadmap that may be used to refine existing palliative care programs and inform implementation of future programs to ensure effective delivery of palliative care for patients with cancer. This project represents an important advance in understanding the role of palliative care specialists in cancer care, as prior work has focused on whether specialist palliative care is associated with improved outcomes, while this work will focus identifying the conditions under which specialist palliative care may achieve improved outcomes.

项目概要 姑息治疗是一种跨学科的护理模式，其总体目标是提高患者的生活质量 通过症状管理、提供社会心理支持、激发 偏好和辅助决策。先前的研究表明，专业姑息治疗是 与治疗强度的降低和生活质量的改善有关，但也表明 姑息治疗团队之间现有的异质性可能与他们的差异性有关 效力。对晚期癌症患者进行专科姑息治疗的早期整合已成为可能 美国临床肿瘤学会推荐。然而，随着医院竞相实施 姑息治疗计划来满足这些指南，但几乎没有证据来指导他们使用哪些成分 是有效提供护理所必需的。拟议的研究将针对这一重要的知识差距：1) 量化癌症专业姑息治疗与临终质量指标之间的关联 护理，2) 检查专业姑息治疗实施是否存在差异（通过关键指标来衡量） 反映团队属性和运营特征的变量）与质量的改进相关 指标和 3) 使用定性研究方法来了解项目如何实施护理服务 在不同的医院环境中。该项目将创建并利用一个新颖的数据源，该数据源结合了 全国患者和医院层面的数据、姑息治疗项目的详细数据以及有关姑息治疗的有效信息 接受专业姑息治疗。随后将对这个独特的数据集进行深入的现场定量分析 参观六个选定的姑息治疗项目；这些数据将共同用于制定可行的路线图 可用于完善现有的姑息治疗计划并为未来计划的实施提供信息 确保为癌症患者提供有效的姑息治疗。该项目代表了一个重要的 进一步了解姑息治疗专家在癌症治疗中的作用，因为之前的工作重点是 专业姑息治疗是否与改善结果相关，而这项工作将重点确定 专业姑息治疗可以取得改善结果的条件。