Parajuli Jyotsana, Chen Zhuo Job, Smith Regine M, Hernandez Liliana M, Norris Savannah, Rutledge Sarah, Williams Grant, Bakitas Marie, Hsiang Simon
University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America.
Atrium Health, Charlotte, North Carolina, United States of America.
PLoS One. 2025 May 21;20(5):e0323366. doi: 10.1371/journal.pone.0323366. eCollection 2025.
INTRODUCTION: Early palliative care (PC) has been recommended for older adults with cancer to address their cancer and treatment related high symptom burden and unmet needs. However, it is underutilized; older adults with cancer are 60% less likely to use PC compared to their younger counterparts. One approach to reduce existing barriers and improve utilization is to assess their readiness for PC. However, there are no gold-standard tools to measure older adults with cancer PC readiness. METHODS: Informed by the 8 domains of PC recommended by National Consensus Project guidelines, Readiness to Change Framework, and principles of community engaged research, we will use a mixed methods approach, to develop and validate a Palliative Care Readiness (PALCARE) Tool through the following steps: 1) Identify items using semi-structured interviews with 20 diverse (race/ethnicity, rural/urban residence, cancer types) older adults with cancer; 2) Develop draft tool via expert panel surveys followed by focus group with PC experts, and 3) Determine item clarity and wording via cognitive interviews with 20 dyads of older adults with cancer and their family caregivers. DISCUSSION/CONCLUSION: The PALCARE tool will be one of the first measures of PC readiness among a diverse sample of older adults with cancer. Once validated, PALCARE can enhance clinical practice by identifying those who are/are not ready for PC, providing targeted PC that is congruent with their readiness, and educating and supporting those who report being not yet ready for PC. The ultimate goal of this study is to improve PC early access and older adults' quality of life.
引言:对于患有癌症的老年人,建议采用早期姑息治疗(PC),以解决他们与癌症及治疗相关的高症状负担和未满足的需求。然而,这种治疗方式未得到充分利用;与年轻的癌症患者相比,老年癌症患者使用PC的可能性要低60%。减少现有障碍并提高利用率的一种方法是评估他们对PC的准备情况。然而,目前尚无衡量老年癌症患者对PC准备情况的金标准工具。 方法:根据国家共识项目指南推荐的PC的8个领域、改变准备框架以及社区参与研究的原则,我们将采用混合方法,通过以下步骤开发和验证姑息治疗准备情况(PALCARE)工具:1)通过对20名不同(种族/民族、农村/城市居住、癌症类型)的老年癌症患者进行半结构化访谈来确定项目;2)通过专家小组调查,随后与PC专家进行焦点小组讨论,制定工具草案;3)通过对20对老年癌症患者及其家庭照顾者进行认知访谈来确定项目的清晰度和措辞。 讨论/结论:PALCARE工具将是首批针对不同老年癌症患者样本的PC准备情况测量工具之一。一旦经过验证,PALCARE可以通过识别那些准备好/未准备好接受PC的患者,提供与其准备情况相符的针对性PC,并对那些报告尚未准备好接受PC的患者进行教育和支持,从而加强临床实践。本研究的最终目标是改善PC的早期获取以及老年人的生活质量。
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