Among terminally ill advanced cancer patients, an inaccurate understanding of prognosis leads to poor treatment decision-making and end-of-life (EOL) care planning, with far reaching negative effects on patient, familial, and societal outcomes. Existing interventions to address this problem have focused on providing patients more information about their prognosis, but have been largely limited in impact, showing that even when given information, patients tend to be unrealistic and inaccurate in their prognostic understanding. Therefore, there is an urgent need for research and interventions that account for the psychological barriers to better patient understanding and outcomes. The candidate?s career goal is to develop an interdisciplinary program of research at the intersection of psychological science, cancer treatment decision-making, and EOL outcomes, that addresses this need. Accordingly, proposed here is a training plan that bridges his background as a clinical psychologist to EOL research. The candidate has a strong background in research examining the psychological processes by which people integrate major, aversive, life experiences (e.g., trauma) into new life goals and expectations. In the K99/R00 projects, he will apply this well-established literature to how advanced cancer patients reconcile the possibility of dying with their goals and expectations, and how this shapes their understanding, decision-making, and EOL outcomes. He will receive interdisciplinary mentorship from experts in EOL research, decision-making, medical oncology, psychiatry, and measurement science. With their mentorship, he will identify and measure the different types of efforts patients use to reconcile the possibility of dying with goals and expectations (Aim 1; K99 phase).
In Aim 2 (R00 phase), the candidate will longitudinally examine the different efforts, to identify which predict better subsequent EOL outcomes, including accurate patient understanding, informed use of anti-cancer treatments, care planning, psychological well-being, receipt of value-consistent care in the final week of life, and post-death impact on caregiver and family.
Aims 1 and 2 will thus lead to a valuable tool for use in future research and identify which ways of managing goals and expectations is most optimal for future outcomes. Interventions could then be developed helping patients employ those efforts that best minimize their distress and allow them to make more optimal decisions and plans. Intermingled with the research aims, is a robust set of training activities giving the candidate interdisciplinary expertise in treatment decision-making, EOL outcomes, and psychology, and skills in measurement development and advanced longitudinal data analysis. Such expertise and skills will allow the candidate to develop an impactful, innovate research program leveraging psychological principles to improve decision-making and EOL outcomes in advanced cancer.
Among patients living with a life-limiting illness, an accurate understanding of prognosis is important for making informed treatment decisions and end-of-life preparations. This proposal aims to identify among advanced cancer patients, the psychological mechanisms that promote, or hinder, accurate understanding and related outcomes (e.g., informed treatment decisions, patient well-being, receipt of value-consistent end-of-life care). The resulting understanding will inform future interventions that help patients with life-limiting illnesses attain better quality of care and outcomes.
