Communicating the Gist of Prognosis: Giving Information Simply and Transparently ("GIST") in Advanced Cancer

传达预后要点：简单透明地提供晚期癌症的信息（“GIST”）

基本信息

批准号：
10000146
负责人：
Andrew Epstein
金额：
$ 25.67万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-08-21 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10000146
关键词：
Address Adult Advance Care Planning Advanced Malignant Neoplasm Agreement Cancer Patient Cardiopulmonary Resuscitation Caregivers Caring Cessation of life Clinic Visits Clinical Cluster randomized trial Communication Decision Making Decision Theory Disease Disseminated Malignant Neoplasm Feedback Future Hearing Immune Targeting Immunotherapy Intensive Care Intensive Care Units Intervention Learning Left Life Expectancy Link Malignant Neoplasms Medical Methods Oncologist Oncology Outcome Palliative Care Patients Phase Quality of life Randomized Reporting Scanning Schedule Site Techniques Testing Therapeutic Time Training Work advanced disease base cancer therapy clinical practice coping end of life end of life care grasp impression improved informant intervention effect meetings outcome forecast palliative patient oriented primary outcome prognostic satisfaction secondary outcome shared decision making targeted treatment treatment as usual

项目摘要

Project Summary/Abstract Despite recent advances in cancer treatments, there still comes a time when the disease progresses, and patients can reliably be expected to have months, but not years, left to live. Although oncologists can reliably predict when patients have months to live, and 71% of advanced cancer patients report wanting prognostic information (with 83% deeming it extremely important), only 17.6% of patients a median of 5 months from death reported a prognostic discussion with their oncologist. Moreover, only 5% of these patients had accurate prognostic understanding. Not only does informed, patient-centered, shared decision-making rely on patients' having a basic understanding of their prognosis, but patients' prognostic understanding has been linked to significantly better end-of-life outcomes (e.g., less burdensome, unbeneficial care; more palliative and value- consistent care). Our prior work thus highlights the need for a communication technique that will prove acceptable to oncologists and that promotes patients' prognostic understanding. To address this need, we developed the “Giving Information Simply &Transparently” (GIST), Oncolo-GIST intervention -- a manualized oncologist communication intervention that simplifies how to impart prognostic information by focusing on 4 basic steps: 1) Giving scan information, 2) Informing prognosis, 3) Strategizing sensitively, and 4) Transparently asking what patients heard. 3 specific aims of the Oncolo-GIST approach will be tested: USpecific Aim #1:U will obtain feedback on Oncolo-GIST Version 1.0 from stakeholders/key informants (n=10 bereaved caregivers; n=10 oncology clinicians) using a modified Delphi approach. USpecific Aim #2:U will determine feasibility and acceptability of Oncolo-GIST Version 1.0 in an open trial of 10 advanced cancer patients. USpecific Aim #3:U will determine whether patients (n=25) meeting with an oncologist randomly assigned to training in Oncolo-GIST Version 2.0 are more likely than patients receiving usual care (n=25) to have better prognostic understanding (e.g., report they likely have months to live), our Uprimary outcomeU. Potential effects on patient: a) engagement in ACP, b) quality of life, receipt of: c) intensive care, d) palliative care, e) value-consistent end-of-life care, and oncologist-reported: f) satisfaction with prognostic discussions and g) therapeutic alliance with patients, will be explored. Results will lead to refinements in the Oncolo-GIST intervention, suggest its clinical feasibility and acceptability, and whether the Oncolo-GIST intervention promotes patients' prognostic understanding and hypothesized "downstream" effects (e.g., less intensive, more palliative care, better patient quality of life). Positive results will support the future testing of the Oncolo- GIST intervention in a multi-site R01 RCT of advanced cancer patients and suggest the potential broader applicability of this "gist" approach to informed end-of-life decision-making.

项目概要/摘要尽管癌症治疗最近取得了进展，但疾病仍然会发展，并且尽管肿瘤学家可以可靠地预计患者只能存活数月，但不能存活数年。预测患者何时还有几个月的生命，71% 的晚期癌症患者表示希望获得预后信息信息（83% 的人认为极其重要），只有 17.6% 的患者中位数为 5 个月死亡报告了与肿瘤科医生的预后讨论，而且这些患者中只有 5% 的结果是准确的。预后理解不仅依赖于患者的知情、以患者为中心的共同决策。对自己的预后有基本的了解，但患者对预后的了解与显着更好的临终结果（例如，减轻负担、无益的护理；更具姑息治疗和价值）因此，我们之前的工作强调需要一种能够证明的沟通技术。为肿瘤学家所接受并促进患者对预后的了解。为了满足这一需求，我们开发了“简单透明地提供信息”(GIST)、Oncolo-GIST 干预措施——一种手动化方法肿瘤科医生沟通干预，通过关注 4 点来简化如何传递预后信息基本步骤：1) 提供扫描信息，2) 告知预后，3) 敏感地制定策略，4) 将测试 Oncolo-GIST 方法的 3 个具体目标：具体目标#1：U将从利益相关者/关键知情人那里获得有关Oncolo-GIST 1.0版的反馈（n=10）失去亲人的护理人员；n=10 名肿瘤学专家）使用修改后的 USpecific 目标 #2：U will。在针对 10 种晚期癌症的公开试验中确定 Oncolo-GIST 1.0 版的可行性和可接受性 U具体目标#3：U将确定患者（n = 25）是否随机与肿瘤科医生会面。分配接受 Oncolo-GIST 2.0 版培训的患者比接受常规护理的患者 (n=25) 更有可能对预后有更好的了解（例如，报告他们可能还有几个月的寿命），这是我们的主要结果。对患者的潜在影响：a) 参与 ACP，b) 生活质量，接受：c) 重症监护，d) 姑息治疗护理，e) 价值一致的临终护理，以及肿瘤学家报告的：f) 对预后讨论的满意度 g) 将探索与患者的治疗联盟，结果将导致 Oncolo-GIST 的改进。干预，提示其临床可行性和可接受性，是否与Oncolo-GIST干预促进患者对预后的理解并辅助“下游”效应（例如强度较低、更多的姑息治疗，更好的患者生活质量）。积极的结果将支持 Oncolo 的未来测试。在晚期癌症患者的多部位 R01 随机对照试验中进行 GIST 干预，并表明潜在的更广泛的研究这种“要点”方法在知情的临终决策中的适用性。