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.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA106370-07
Application #
8209215
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
O'Mara, Ann M
Project Start
2004-04-01
Project End
2015-01-31
Budget Start
2012-02-01
Budget End
2013-01-31
Support Year
7
Fiscal Year
2012
Total Cost
$444,767
Indirect Cost
$87,748
Name
Dana-Farber Cancer Institute
Department
Type
DUNS #
076580745
City
Boston
State
MA
Country
United States
Zip Code
02215
Su, Amanda; Lief, Lindsay; Berlin, David et al. (2018) Beyond Pain: Nurses' Assessment of Patient Suffering, Dignity, and Dying in the Intensive Care Unit. J Pain Symptom Manage 55:1591-1598.e1
Kurita, Keiko; Siegler, Eugenia L; Reid, M Cary et al. (2018) It Is Not What You Think: Associations Between Perceived Cognitive and Physical Status and Prognostic Understanding in Patients With Advanced Cancer. J Pain Symptom Manage 56:259-263
Trevino, Kelly M; Litz, Brett; Papa, Anthony et al. (2018) Bereavement Challenges and Their Relationship to Physical and Psychological Adjustment to Loss. J Palliat Med 21:479-488
Trevino, Kelly M; Prigerson, Holly G; Maciejewski, Paul K (2018) Advanced cancer caregiving as a risk for major depressive episodes and generalized anxiety disorder. Psychooncology 27:243-249
Muñoz, Francisco V; Larkey, Linda (2018) THE CREATIVE PSYCHOSOCIAL GENOMIC HEALING EXPERIENCE (CPGHE) AND GENE EXPRESSION IN BREAST CANCER PATIENTS: A FEASIBILITY STUDY. Adv Integr Med 5:9-14
Li, David; Prigerson, Holly G; Kang, Josephine et al. (2017) Impact of Radiation Therapy on Aggressive Care and Quality of Life Near Death. J Pain Symptom Manage 53:25-32
Nissen, Kathrine G; Trevino, Kelly; Lange, Theis et al. (2016) Family Relationships and Psychosocial Dysfunction Among Family Caregivers of Patients With Advanced Cancer. J Pain Symptom Manage 52:841-849.e1
Maciejewski, Paul K; Maercker, Andreas; Boelen, Paul A et al. (2016) ""Prolonged grief disorder"" and ""persistent complex bereavement disorder"", but not ""complicated grief"", are one and the same diagnostic entity: an analysis of data from the Yale Bereavement Study. World Psychiatry 15:266-275
Trevino, Kelly M; Zhang, Baohui; Shen, Megan J et al. (2016) Accuracy of advanced cancer patients' life expectancy estimates: The role of race and source of life expectancy information. Cancer 122:1905-12
Epstein, Andrew S; Prigerson, Holly G; O'Reilly, Eileen M et al. (2016) Discussions of Life Expectancy and Changes in Illness Understanding in Patients With Advanced Cancer. J Clin Oncol 34:2398-403

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