Enhancing Triadic Communication About Cognition for Older Adults with Alzheimer's Disease or Related Dementias Facing a Cancer Management Decision

加强患有阿尔茨海默病或相关痴呆症的老年人面临癌症管理决策时关于认知的三元沟通

• 批准号: 10436554
• 负责人: Allison Marian Magnuson
• 金额: $ 42.28万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10436554
• 关键词: Advanced Malignant Neoplasm; Aging; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Anxiety; Behavioral; Benefits and Risks; Biometry; Cancer Patient; Caregivers; Caring; Climate; Clinical Oncology; Cluster randomized trial; Cognition; Cognitive; Communication; Communication Tools; Community Clinical Oncology Program; Complex; Cues; Data; Decision Making; Dementia; Depressed mood; Diagnosis; Elderly; Enrollment; Ensure; Equilibrium; Focus Groups; Geriatric Assessment; Goals; Healthcare; Impaired cognition; Intervention; Knowledge; Malignant Neoplasms; Measures; Medical; Methods; Morbidity - disease rate; Nature; Oncologist; Oncology; Outcome; Palliative Care; Patient Care; Patient-Focused Outcomes; Patients; Perception; Personal Satisfaction; Physicians; Population; Population Intervention; Process; Quality of life; Questionnaires; Randomized; Recommendation; Regrets; Research; Science; Symptoms; Training; Triad Acrylic Resin; Universities; base; behavioral neurology; cancer care; cancer clinical trial; cancer therapy; clinical diagnosis; clinical encounter; efficacy evaluation; experience; improved; individual patient; innovation; mortality; multidisciplinary; older patient; phase 3 study; post intervention; preference; primary outcome; programs; response; secondary analysis; side effect; skills; telephone coaching; therapy development; tool; treatment as usual

Project Summary: The overarching goal of this proposal, submitted in response to RFA-AG-22-020, is to adapt an existing communication tool developed by our team for use in patients with Alzheimer’s Disease or Related Dementias (ADRD) and their care partners, and to evaluate if this tool can enhance communication about cognition in the context of a cancer management decision. This proposal is important because approximately 7% of older adults diagnosed with cancer have pre-existing dementia. For older adults with ADRD and cancer, medical decision making is more complex, and integrates information about the risks and benefits of potential interventions in the context of the dual diagnoses. Limited data are available to guide the “best” approach and thus, relies on discussions about the risks and benefits of options in the context of patient and care partner goals and preferences. Unfortunately, there is no standard approach among oncology clinicians as to how to discuss cognition in the context of a cancer management decision for patients with pre- existing ADRD and their care partners. Preliminary research by the PI (Magnuson) and team suggest that cognitive impairment is prevalent in older patients with cancer and that a geriatric assessment-based communication tool can facilitate conversations about aging-related conditions, such as cognition, with older patients and their care partners. However, the intervention was not tested in patients with ADRD and did not address patient and care partner concerns about cognition in the context of cancer. Adapting this tool for patients with ADRD (adapted tool called “COACH-Cog”) may improve both care partner and patient outcomes through greater acknowledgement and support of cognitive concerns and cognitive-related goals, thereby improving goal concordant care. COACH-Cog adaptations will include: 1) brief, focused training for oncology clinicians about ADRD in the context of cancer and communication training to navigate the triadic nature of these conversations, thereby enhancing oncology clinician knowledge and supporting their decision processes; and 2) care partner and patient Communication Coaching and Question Prompt List providing knowledge, skills, and behavioral cueing for discussing their cognitive concerns and cognitive-related goals with oncology clinicians. Focus groups with key stakeholders will guide the adaptation. Subsequently, we propose to conduct a pilot, Stage I RCT (cluster randomized at physician) with older adults with a clinical diagnosis of ADRD and their care partners (N=130 dyads) to evaluate the preliminary efficacy of COACH-Cog on care partner and patient autonomy support, care partner well-being, and goal concordance in outcomes at 3 months. Our uniquely qualified, multidisciplinary team includes expertise in geriatric oncology, cognition, behavioral neurology, intervention development, communication science, biostatistics, palliative care, and care partner research. This innovative proposal will develop a pragmatic tool for improving communication about cognition in the context of cancer treatment decision making for patients with ADRD and their care partners.

项目摘要：根据RFA-AG-22-020提交的该提案的总体目标是 适应我们的团队开发的现有通信工具，用于在阿尔茨海默氏病或 相关痴呆症（ADRD）及其护理伙伴，并评估此工具是否可以增强通信 关于癌症管理决策的背景下的认知。该建议很重要，因为 大约7％的被诊断为癌症的老年人患有痴呆症。对于老年人 ADRD和癌症，医疗决策更加复杂，并整合了有关风险和的信息 在双重诊断的背景下潜在干预措施的好处。有限的数据可用于指导 “最佳”方法，因此依靠讨论患者的选择的风险和好处 以及护理合作伙伴的目标和偏好。不幸的是，肿瘤学没有标准的方法 临床医生关于如何在癌症管理决策的背景下讨论认知的患者 现有的ADRD及其护理伙伴。 PI（Magnuson）和团队的初步研究表明 认知障碍在老年癌症患者中普遍存在，并且是基于老年评估的患者 沟通工具可以促进与衰老相关疾病（例如认知）的对话，较旧 病人及其护理伙伴。但是，该干预措施尚未在ADRD患者中进行测试，没有 解决患者和护理伴侣对癌症认知的关注。适应此工具 ADRD的患者（称为“ Coach-Cog”的改编工具）可以改善护理伙伴和患者结果 通过更大的认可和支持认知问题和与认知相关的目标 改善目标一致性护理。 Coach-Cog改编将包括：1）简短的，重点的肿瘤学培训 临床医生关于癌症和传播训练的背景下的ADRD，以导航三合会的性质 这些对话，从而增强了肿瘤学临床知识并支持其决策过程； 2）护理伙伴和患者沟通教练和问题提示清单提供知识， 技能和行为提示与肿瘤学讨论其认知问题和与认知相关的目标 临床医生。与主要利益相关者的焦点小组将指导改编。随后，我们建议进行 试点I阶段RCT（在物理上随机分组）与具有ADRD临床诊断的老年人 他们的护理伙伴（n = 130个二元组）评估Coach-Cog在护理伙伴和 患者自主权支持，护理伙伴福祉和目标在3个月的结果中的目标一致性。我们的 具有独特资格的多学科团队包括老年肿瘤学，认知，行为的专业知识 神经病学，干预发展，传播科学，生物统计学，姑息治疗和护理伙伴 研究。这项创新的建议将开发一种务实的工具，用于改善有关认知的沟通 在针对ADRD患者及其护理伙伴的癌症治疗决策的背景下。