Compared to whites, Latinos are much less likely to engage in various forms of advance care planning (ACP), including completing advance directives and having end-of-life (EOL) discussions. ACP is critical to provision of quality EOL care, as it has been associated with greater likelihood of patients' EOL wishes being followed. Latino advanced cancer patients are also significantly more likely than their white counterparts to receive futile and burdensome aggressive care at the end-of-life, to die in the ICU, and to have care that runs counter to their preferences and values. Dr. Shen's pilot work, along with the current literature, suggests that targeting ACP may help improve Latinos' EOL care. As such, the proposed project will develop and pilot-test a culturally competent communication (CCC) intervention. First, the CCC intervention will be developed based on results from a questionnaire embedded into a current R01 (MPIs: Prigerson, Maciejewski) assessing Latinos' cultural, familial, and religious beliefs as well as their knowledge, motivation (readiness), and action to engage in ACP (n=200). Next, the developed CCC intervention will be vetted among Latino stakeholders and field-tested among Latino advanced cancer patients, using an iterative approach (n=40) to guide the finalization of the intervention. Finally, a pilot randomized trial will examine the feasibility, acceptability, and potential efficacy of the CCC intervention at improving engagement in ACP. Participants (n=50) will be randomly assigned to the intervention (n=25) or attention control group (n=25). Results will provide timely insight into a potentially effective, low burden intervention designed to improve Latinos' engagement in ACP. Dr. Shen is the ideal candidate to spearhead this line of research given her academic background in social psychology and communication research. Dr. Shen's long-term career goal is to lead a program of social scientific research that develops social psychological interventions designed to improve EOL communication and care, with expertise in interventions targeting racial/ethnic minorities. To achieve this goal, as part of her K07, Dr. Shen will receive intensive training in five key areas: (1) EOL care research; (2) clinical intervention development; (3) technology-based health interventions; (4) health disparities, and (5) professional development. The K07 will provide Dr. Shen with several avenues to achieve her training and research goals and enhance her expertise. Dr. Shen will have ongoing meetings with mentors and expert advisors and participate in formal coursework, didactics, workshops, conferences, interactive trainings, and guided research experience. The proposed K07 will form the foundation for a program of research that focuses on developing social psychological interventions to improve EOL communication and care. At the end of the K07 funding period, Dr. Shen will submit an R01 application, based on the results of the present study. Overall, the K07 will provide Dr. Shen with the research experience, intensive training, and mentorship needed to become a successful independent researcher.
The proposed research has significant public health relevance and is consistent with the broader goals of public health focuses on improving communication regarding end-of-life care. The development of a Culturally Competent Communication Intervention designed to coach Latino advanced cancer patients in how to communicate EOL goals of care in order to improve their engagement in advance care planning will help reduce Latino/non-Latino disparities in advance care planning and potentially end-of-life care. If the Culturally Competent Communication Intervention proves to be potentially efficacious, there is a strong argument for testing this intervention in a larger, multi-site study to test for effectiveness.
| Shen, Megan Johnson; Wellman, Joseph D (2018) Evidence of palliative care stigma: The role of negative stereotypes in preventing willingness to use palliative care. Palliat Support Care :1-7 |
| Shen, Megan Johnson; Prigerson, Holly G; Ratshikana-Moloko, Mpho et al. (2018) Illness Understanding and End-of-Life Care Communication and Preferences for Patients With Advanced Cancer in South Africa. J Glob Oncol :1-9 |
| Johnson Shen, Megan; Freeman, Ryann; Karpiak, Stephen et al. (2018) The Intersectionality of Stigmas among Key Populations of Older Adults Affected by HIV: a Thematic Analysis. Clin Gerontol :1-13 |
| Trevino, Kelly M; Maciejewski, Paul K; Shen, Megan Johnson et al. (2018) How much time is left? Associations between estimations of patient life expectancy and quality of life in patients and caregivers. Support Care Cancer : |
