Coping with Cancer II
The 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 in 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 guide 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.
We propose to enroll 200 patients (half black and half white) with Stage III thoracic (pulmonary, mediastinal, pericardial, and pleural lesions, and cancers affecting the chest wall and sternum), GI (esophageal, pancreatic, liver, gastric and stomach, not colon) cancer, or ovarian canceer from the Parkland oncology clinic and the Simmons Cancer Center over a four year period. 300 patients will be recruited from other sites in Boston (MA) and Richmond (VA). Enrolled patients, caregivers, and the patient?s primary oncology provider will be interviewed at baseline and the first visit with the oncologist audiotaped. Information from each survey will be correlated with the audiotape to determine possible differences between perception, recollection, and what was actually said. Subsequently, patients will be interviewed monthly to evaluate changes in terminal illness acceptance, quality of life, and communication goals (e.g., desire to learn prognostic information) evolve over time After the patient?s death, details about type of care received and a subjective evaluation of the patient?s quality of life in the last days will be extracted from the chart and collected in an interview with both the nurse who last cared for the patient and the family/friend caregiver interviewed at baseline. This data will allow us to analyze the extent to which communication processes (e.g., by whom, when, how prognoses are disclosed) vary by ethnicity, and how those differences translate into ethnic disparities at EOL. Results will indicate which communication processes and communication goals (e.g., patient acceptance of terminal illness) are promising targets for interventions to reduce black-white disparities in EOL health care and improve quality of life for all cancer patients.
• Black and non-Hispanic white adult cancer patients
• Have failed first-line chemotherapy and have GI cancer (unresectable pancreatic cancer, metastatic gastric, stomach, esophageal, liver, not colon), lung cancer (pulmonary, mediastinal, and pleural/chest wall), or platinum refractory/resistant ovarian cancer and who are still getting chemotherapy.
• From Parkland Oncology Clinic and the Simmons Comprehensive Cancer Center.