Psychological Responses to the Possibility of Dying: Decision-Making Implications for Advanced Cancer Patients - Project Summary
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.
