The goal of the proposed research training plan is to enable the applicant to develop the knowledge and skills necessary to serve as the foundation of a program of research focused on improving end-of-life (EOL) decision-making and communication among African Americans (AAs). AAs are disproportionately affected by high morbidity and mortality rates from cancer. Compared to Caucasians, death rates for all cancers combined are 32% and 16% higher in AA men and women, respectively [1]. Thus, many AAs with advanced cancer could benefit from comfort-focused care (CFC) at the end of life (EOL), such as hospice or palliative care [2]. AAs often choose life-prolonging treatments (LPT) despite a small chance of cure [3-7]. CFC has repeatedly been shown to have beneficial patient and family outcomes [8-11]. However, although AAs represent 12.6% [12]of the population in the United States, they represented only 8.7% of all 2009 hospice enrollees [2]. Evidence suggests the factors that contribute to the AA EOL decision-making process are multifaceted and include a blend of patient and family characteristics and several patient-family-provider interaction factors. Of the factors contributing to such decision-making, communication is a critical component [13-15]. Enhancing EOL discussions and improving understanding of EOL decision-making among patients with advanced cancer and their families are important to foster patient and family-centered care at EOL [16]. To improve AA decision-making at EOL, it is essential to understand patient and family perceptions related to the decision to continue or discontinue LPTs and to ascertain the underlying elements that contribute to differences in decision-making among AA family members. A conceptual framework informed by the literature and the Ottawa Decision Support Framework (ODSF) will guide this study of care decision-making related to AAs with advanced cancer from the perspectives of their bereaved family members. The purpose of this mixed methods study is to examine AA family members'perceptions of the factors that influenced EOL decision-making for their family member who died from advanced cancer using Ottawa Decision Support (ODS) instruments and after-death semi-structured interviews. Forty-eight bereaved family members will participate in the telephone interview using quantitative structured data collection tools and 15 will participate in the qualitative semi- structured interviews.

Public Health Relevance

Many African Americans with advanced cancer could benefit from comfort-focused care such as hospice at the end-of-life, but most choose life-prolonging treatments that have little chance of success. Improvements in end-of-life communication among health care providers, patients, and families would help decision-making in this population, which has relatively high mortality rates from cancer. This study will provide information that will help us to understand how decisions are made in this situation, which in turn will lead to interventions to improve care for African Americans with advanced cancer and their families.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZNR1)
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Banks, David
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Indiana University-Purdue University at Indianapolis
Schools of Nursing
United States
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Smith-Howell, Esther R; Hickman, Susan E; Meghani, Salimah H et al. (2016) End-of-Life Decision Making and Communication of Bereaved Family Members of African Americans with Serious Illness. J Palliat Med 19:174-82