Latinos receive more aggressive, burdensome end-of-life (EOL) care (eg, ICU stays, resuscitation) and less hospice care than non-Latino whites. The available evidence suggests that the EOL care Latinos receive may be suboptimal and inconsistent with their wishes, and inferior to the EOL care that whites receive. The overarching aim of this study is to identify the most promising targets for interventions designed to enable Latinos to receive: a) high quality EOL care, and b) care consistent with their values and preferences (""""""""treatment goal attainment""""""""). Our preliminary results, and those of others, suggest that there is a critical need for data at institutional, provider, and patient levels so that their relative influence can be discerned. The primary aims ofthe proposed study are to obtain multi-level data and use hierarchical linear modeling (HLM) to estimate patient, provider and institutional effects on Latino-white disparities in EOL care and treatment goal attainment. We hypothesize the primacy of patient and provider over institution effects, which will be significant, but less influential than either patient or provider effects. We will recruit 250 advanced gastrointestinal and thoracic cancer patients (125 Latino, 125 non-Latino white) with a life-expectancy of less than 6 months from five sites across the US. We will also enroll 50 oncology providers overall who each care for at least 5 study participants The patient's medical care received in the last month of life will be documented via medical chart extraction in the postmortem assessment. We anticipate that this study will inform policy makers and institutional leadership of where they should invest for the greatest """"""""bang for the buck"""""""" to reduce Latino-white disparities in EOL care. The study team, comprised of Dr. Holly Prigerson, a leading expert in EOL care, and Dr. Jan Mutchler, a nationally recognized gerontologist with strong interests in disparities, is well-poised to undertake this work, in collaboration with a junior investigator at DFCI (Jimenez) and a UMB Associate Professor who wants to increase her research skills and expertise (Rivera). This project will benefit significantiy from support provided by the Training and Survey and Statistical Methods Cores.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
5U54CA156732-03
Application #
8378207
Study Section
Special Emphasis Panel (ZCA1-SRLB-3)
Project Start
Project End
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
3
Fiscal Year
2012
Total Cost
$594,171
Indirect Cost
$362,681
Name
Dana-Farber Cancer Institute
Department
Type
DUNS #
076580745
City
Boston
State
MA
Country
United States
Zip Code
02215
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
Allen, Jennifer D; Torres, Maria Idalí; Tom, Laura S et al. (2016) Dissemination of evidence-based cancer control interventions among Catholic faith-based organizations: results from the CRUZA randomized trial. Implement Sci 11:74
Abel, Gregory A; Albelda, Randy; Khera, Nandita et al. (2016) Financial Hardship and Patient-Reported Outcomes after Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 22:1504-10
Shen, Megan Johnson; Prigerson, Holly G; Paulk, Elizabeth et al. (2016) Impact of end-of-life discussions on the reduction of Latino/non-Latino disparities in do-not-resuscitate order completion. Cancer 122:1749-56
Garrido, Melissa M; Prigerson, Holly G; Bao, Yuhua et al. (2016) Chemotherapy Use in the Months Before Death and Estimated Costs of Care in the Last Week of Life. J Pain Symptom Manage 51:875-881.e2
LeBaron, Virginia T; Smith, Patrick T; Quiñones, Rebecca et al. (2016) How Community Clergy Provide Spiritual Care: Toward a Conceptual Framework for Clergy End-of-Life Education. J Pain Symptom Manage 51:673-81
Allen, Jennifer D; Tom, Laura S; Leyva, Bryan et al. (2015) Recruiting and Surveying Catholic Parishes for Cancer Control Initiatives: Lessons Learned From the CRUZA Implementation Study. Health Promot Pract 16:667-76
Allen, Jennifer D; Torres, Maria Idali; Tom, Laura S et al. (2015) Enhancing organizational capacity to provide cancer control programs among Latino churches: design and baseline findings of the CRUZA Study. BMC Health Serv Res 15:147
McCauley, M P; Ramanadhan, S; Viswanath, K (2015) Assessing opinions in community leadership networks to address health inequalities: a case study from Project IMPACT. Health Educ Res 30:866-81
LeBaron, Virginia T; Blonquist, Traci M; Hong, Fangxin et al. (2015) Screening for Pain in the Ambulatory Cancer Setting: Is 0-10 Enough? J Oncol Pract 11:435-41

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