The objective of the study is to improve the quality of advanced cancer care and treatment decision-making for Latinos by developing a tailored video intervention to better inform patients about their illness, prognosis, and chemotherapy risks/benefits. Latinos with incurable cancer harbor markedly optimistic expectations of prognosis, and often receive palliative chemotherapy without understanding that it is unlikely to cure. Such misconceptions are much more prevalent among Latinos than Whites, and may contribute to Latino/non-Latino disparities in end-of-life (EOL) care such as lower rates of advance care planning, underutilization of hospice and greater intensity of EOL care. Latino advanced cancer patients face formidable cultural, linguistic, and structural barriers to accessing critical information about their disease and treatment options. Nevertheless, interventions to enhance Latinos' understanding are few and underdeveloped. Prior to starting treatment, oncologists typically discuss the risks and benefits of chemotherapy, and patients sign written informed consent. This proposal capitalizes on the chemotherapy informed consent (IC) process as a strategic opportunity to equip Latinos with a better understanding of their illness and treatment options. In prior work, Drs. Schrag and Enzinger (DF/HCC) developed a suite of videos and booklets to support IC for common chemotherapy regimens used to treat advanced GI cancers, which balance attention to risks and benefits, offer context about the underlying cancer, and include patient voices. Leveraging Dr. Lindsay's (UMass Boston) skills in Latino community engagement, mixed methods research, and Latino health disparities, the team will adapt the videos to attend to the needs of Latinos-both Spanish and English speakers.
In Aim 1) the study team will use a four-phase qualitative research process to ensure that IC tools meet the informational, cultural, and linguistic needs of Latinos with advanced GI cancer.
In Aims 2 & 3) the resulting Spanish-English suite of IC tools will be tested to determine its effect on Latino patients' and caregivers' decision-making about cancer treatment and EOL care, and their satisfaction with communication processes and cancer care. This will be accomplished through a multicenter randomized trial involving 116 Latinos with advanced GI cancers and their caregivers, recruited from seven academic and community cancer centers serving diverse Latino populations. This intervention is practical, scalable and has immense potential to impact the quality of cancer care provided to Latinos. This project aligns with the U54 Partnership as it aims to reduce cancer disparities by improving communication with Latinos. The project prioritizes involvement of Latino students to foster the next generation of URM researchers and more fully harmonize the research with the needs and perspectives of the broader Latino community. Finally, this project forges and solidifies relationships with Latino communities, and harnesses the complementary expertise of its DF/HCC and UMass Boston investigators, thereby laying the groundwork for a sustainable partnership for cross-cutting cancer disparities research.
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