Improving person-centered communication of goals, proxy, and advance directives in older patients with advanced cancer: Secondary analysis from a University of Rochester NCI Community Oncology Research Program (NCORP) cluster randomized controlled trial (CRCT).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11523-11523
Author(s):  
Marie Anne Flannery ◽  
Eva Culakova ◽  
Kah Poh Loh ◽  
Ronald M. Epstein ◽  
Charles Stewart Kamen ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Advance Directives ◽  
Advance Directive ◽  
Older Patients ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Community Based ◽  
Oncology Research ◽  
Patient Goals ◽  
Age Related

11523 Background: Quality person-centered care relies on effective communication between the clinical team and the patient/caregiver eliciting goals and discussing wishes. In a PCORI- and NCI-funded CRCT, we found that providing community-based oncologists with geriatric assessment-guided recommendations led to more and higher quality discussions of age-related issues for older patients with advanced cancer. In this secondary analysis, we assessed whether specific recommendations to oncologists to discuss patient goals, proxy and advance directives resulted in increased communication about these topics. Methods: Patients aged 70+ with advanced solid tumors or lymphoma and at least one impaired geriatric domain (e.g., function, cognition) were enrolled (URCC 13070; PI: Mohile). Oncology practices were randomized to the intervention (oncologists received recommendations to elicit goals and discuss wishes) or usual care. The clinic visit after the oncologist received recommendations was recorded and transcribed; two blinded coders evaluated the transcripts for discussion of the specific topic areas recommended in the intervention. Between arm differences were compared using generalized linear models controlling for practice cluster. Results: From 2014-17, 528 patients (284 intervention) provided transcripts from 31 practices (mean age = 77, range 70-96 years; 49% female; mixed cancer diagnoses). Topics related to patient goals, proxy and advance directive wishes were more often discussed in the intervention arm (goals of care preferences: 9 vs 2%, p = .02, treatment goals: 35 vs 20%. p = .04, elicit caregiver input: 28 vs 3%. p < .01, assess values and goals: 25 vs 7%, p = .07, health care proxy: 40 vs 1%, p = .004, advance directive: 25 vs 1%, p = .002). Conclusions: In this community-based study of older adults providing recommendations to oncologists to discuss specific topics resulted in increased person-centered discussions with patients and caregivers about goals, proxy and advance directive wishes. However, the content areas were discussed in less than half of all visits. Clinical trial information: NCT02107443.

Improving communication with older patients with cancer using geriatric assessment (GA): A University of Rochester NCI Community Oncology Research Program (NCORP) cluster randomized controlled trial (CRCT).

2018 ◽  
Vol 36 (18_suppl) ◽  
pp. LBA10003-LBA10003 ◽  
Author(s):  
Supriya Gupta Mohile ◽  
Ronald M. Epstein ◽  
Arti Hurria ◽  
Charles E. Heckler ◽  
Paul Duberstein ◽  
...  
Keyword(s):  
Usual Care ◽  
Older Patients ◽  
Controlled Trial ◽  
Intraclass Correlation ◽  
Clinic Visit ◽  
Adverse Outcomes ◽  
Oncology Research ◽  
Age Related ◽  
Cluster Randomized

LBA10003 Background: GA includes validated measures that assess age-related health domains (e.g., function, cognition) known to increase adverse outcomes. In this PCORI and NCI funded CRCT, we evaluated if providing a GA summary and recommendations for GA-guided interventions improves communication about age-related concerns for older patients (pts) with cancer. Methods: Pts aged ≥ 70 with advanced solid tumors or lymphoma and at least 1 impaired GA domain were enrolled. Oncology practices were randomized to intervention (oncologists received GA summary) or usual care (no summary provided). The primary outcomes were: 1) number of discussions about age-related concerns (the clinic visit after GA was audio-recorded and transcribed; 2 blinded coders evaluated quality of communication and plan for follow-up interventions) and 2) telephone surveys of patient satisfaction (modified Health Care Climate Questionnaire [HCCQ-age] scored 7-35). Outcomes were analyzed using linear mixed models with arm as the fixed effect, controlling for practice. Results: From 2014-17, 544 pts (295 in GA) were enrolled from 31 practices. There were no differences in demographics by arm (mean age 77 yrs; 49% female). More patients in usual care had impaired physical performance (96% vs 92%, p = 0.03) and social support (33% vs 25%, p = 0.05). In 530 evaluable pts, the overall mean number of discussions was 6.3 (SD: 4.0). The GA arm had 3.5 more discussions about age-related concerns (95%CI: 2.28-4.72, p = 10-6; intraclass correlation coefficient [ICC] = 0.24) compared to usual care; of these, in the GA arm, 2.0 more discussions on average had higher quality communication (95%CI: 1.20-2.69; p = 6x10-6) and 1.9 more led to interventions (95% CI: 1.14-2.73; p = 1.6x10-5). The GA arm had significantly more discussions for almost all GA domains. In 511 pts with HCCQ-age, the mean score was 22.9 (SD 4.5); the score was 1.12 points higher in the GA arm (95%CI: 0.23-2.03; p = .027; ICC = 0.02). Conclusions: Providing a GA summary to oncologists increases the number and quality of discussions about age-related concerns and improves pt satisfaction. Clinical trial information: NCT02107443.

A geriatric assessment (GA) intervention for older patients with advanced cancer: Secondary outcomes from a University of Rochester cancer center NCI community oncology research program cluster randomized controlled trial (CRCT).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 33-33
Author(s):  
Supriya Gupta Mohile ◽  
Mostafa Mohamed ◽  
Huiwen Xu ◽  
Amita Patil ◽  
Eva Culakova ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Older Patients ◽  
Controlled Trial ◽  
Depression Scale ◽  
Cancer Center ◽  
Oncology Research ◽  
Community Oncology ◽  
Treatment Type ◽  
Patient Reported ◽  
Secondary Outcomes

33 Background: GA evaluates aging-related domains (e.g., function) known to be associated with cancer treatment toxicity. We found that providing a GA summary with management recommendations to oncologists reduces clinician-rated toxicity in older patients (pts) with advanced cancer receiving high risk treatment (presented @ASCO2020). Herein, we report secondary outcomes on the effects of the GA intervention on aging-related outcomes. Methods: Pts aged ≥ 70 with incurable solid tumors or lymphoma and ≥ 1 impaired GA domain starting a new treatment regimen were enrolled. Community oncology practices were randomized to intervention (oncologists received GA summary/recommendations) or usual care (none given). Secondary analyses examined effects of the intervention on functional outcomes (patient-reported falls, instrumental activities of daily living (IADL), short physical performance battery (SPPB), geriatric depression scale (GDS), and medications [total and prescription]). Outcomes were analyzed using linear mixed effects model, logistic or Poisson regression adjusted for baseline values, time, and site effects as appropriate. Results: From 2013-19, 718 pts were enrolled from 41 practices. Age (mean 77 yrs), sex (43% women), number of impaired GA domains (median 4/8), and treatment type (chemotherapy 88%) were not different by arm. More pts in intervention were black (12% vs 3%, p<0.01), had GI cancer (38% vs 31%, p<0.01), and had prior chemotherapy (31% vs 23%, p=0.02). Overall, 16.4% of all pts had one new fall over 3 months; patients in the intervention arm were significantly less like to fall over 3 months (11.7% vs 20.7%; Risk Ratio 0.58; 95% CI 0.40-0.84, p=0.004). There was no difference in the total number of medications (mean 5.86 vs 5.79, p=0.80) and prescriptions (mean 4.26 vs 4.20, p=0.70) at baseline. More medications (adjusted mean 0.23 vs 0.09, p=0.03) and prescriptions (0.19 vs 0.07, p=0.05) were discontinued during intervention, although there was no difference at 3 month follow up. There were no significant between-arms differences in IADL, SPPB, and GDS. Conclusions: Providing GA information to oncologists reduces the proportion of older pts who experience a fall over 3 months and improves polypharmacy; both of these endpoints are of clinical importance to older adults with aging-related conditions and advanced cancer undergoing palliative treatment. Funding: R01CA177592, U01CA233167, UG1CA189961. Clinical trial information: NCT02054741 .

The association between religiosity and resuscitation status preference among patients with advanced cancer

2015 ◽  
Vol 13 (5) ◽  
pp. 1435-1439 ◽  
Author(s):  
Marvin O. Delgado-Guay ◽  
Gary Chisholm ◽  
Janet Williams ◽  
Eduardo Bruera
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Short Form ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Religious Faith ◽  
Communication Style ◽  
Do Not Resuscitate ◽  
Advanced Cancer Patients ◽  
Resuscitation Status

AbstractObjective:The potential influence of patient religious and spiritual beliefs on the approach to end-of-life care and resuscitation status preferences is not well understood. The aim of this study was to assess the association between religiosity and resuscitation preferences in advanced-cancer patients.Method:We performed a secondary analysis of a randomized controlled trial that evaluated the influence of physician communication style on patient resuscitation preferences. All patients completed the Santa Clara Strength of Religious Faith Questionnaire–Short Form (SCSRFQ–SF) and expressed their resuscitation preferences. We determined the frequency of resuscitation preferences and its association with intensity of religiosity.Results:A total of 78 patients completed the study. The median age was 54 years, with a range of 18–78. Some 46 (59%) were women; 57 patients (73%) were Caucasian, 15 (19%) African American, and 5 (7%) Hispanic. A total of 46 patients (56%) were Protestant and 13 (17%) Catholic. Some 53 of 60 patients who chose Do Not Resuscitate status (DNR) (88%) and 16 of 18 patients who refused DNR (89%) for a video-simulated patient were highly religious (p = 0.64). When asked about a DNR for themselves after watching the videos, 43 of 48 who refused DNR (90%) and 26 of 30 patients who chose DNR (87%) were highly religious (p = 0.08). The Spearman correlation coefficient for patients choosing DNR for themselves and intensity of religiosity was r = –0.16 (p = 0.16). Some 30 patients (38%) who chose DNR for the video patient refused DNR for themselves, and 42 who chose DNR for both the video patient and themselves (54%) were highly religious (p = NS).Significance of Results:There was no significant association between intensity of patient religiosity and DNR preference for either the video patient or the patients themselves. Other beliefs and demographic factors likely impact end-of-life discussions and resuscitation status preferences.

scholarly journals Advance directives for patients compulsorily admitted to hospital with serious mental illness

2002 ◽  
Vol 181 (6) ◽  
pp. 513-519 ◽  
Author(s):  
Alexia Papageorgiou ◽  
Michael King ◽  
Anis Janmohamed ◽  
Oliver Davidson ◽  
John Dawson
Keyword(s):  
Mental Illness ◽  
Advance Directives ◽  
Advance Directive ◽  
Primary Outcome ◽  
Psychiatric Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Psychiatric Services ◽  
Control Group ◽  
Randomised Controlled

BackgroundAn advance directive is a statement of a person's preferences for treatment, should he or she lose capacity to make treatment decisions in the future.AimsTo evaluate whether use of advance directives by patients with mental illness leads to lower rates of compulsory readmission to hospital.MethodIn a randomised controlled trial in two psychiatric services in inner London, 156 in-patients about to be discharged from compulsory treatment under the Mental Health Act were recruited. The trial compared usual psychiatric care with usual care plus the completion of an advance directive. The primary outcome was the rate of compulsory readmission.ResultsFifteen patients (19%) in the intervention group and 16 (21%) in the control group were readmitted compulsorily within 1 year of discharge. There was no difference in the numbers of compulsory readmissions, numbers of patients readmitted voluntarily, days spent in hospital or satisfaction with psychiatric services.ConclusionsUsers' advance instruction directives had little observable impact on the outcome of care at 12 months.

scholarly journals Tailored Web-Based Information for Younger and Older Patients with Cancer: Randomized Controlled Trial of a Preparatory Educational Intervention on Patient Outcomes

10.2196/14407 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e14407 ◽  
Author(s):  
Minh Hao Nguyen ◽  
Ellen M A Smets ◽  
Nadine Bol ◽  
Eugène F Loos ◽  
Hanneke W M van Laarhoven ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Older Patients ◽  
Controlled Trial ◽  
Newly Diagnosed ◽  
Web Based ◽  
Younger Patients ◽  
Information Recall ◽  
Patients With Cancer ◽  
Randomized Controlled ◽  
Age Related

Background Many patients with cancer, including older patients (aged ≥65 years), consult the Web to prepare for their doctor’s visit. In particular, older patients have varying needs regarding the mode in which information is presented (eg, via textual, visual, or audiovisual modes) owing to age-related sensory (eg, impaired vision and hearing) and cognitive decline (eg, reduced processing speed). Therefore, Web-based information targeted at older patient populations is likely to be used and processed more effectively, and evaluated more positively, when tailored to age-related capabilities and preferences. This, in turn, may benefit patient outcomes. Objective This randomized controlled trial tested the effects of a Web-based tailored educational intervention among newly diagnosed younger (<65 years) and older (≥65 years) patients with cancer. We compared the intervention group who viewed a mode-tailored website (ie, enabling patients to tailor information using textual, visual, and audiovisual modes) with 3 control groups view a nontailored website (ie, text only, text with images, and text with videos). We examined website experience outcomes (ie, website satisfaction, website involvement, knowledge, anxiety, and communication self-efficacy) and consultation experience outcomes (ie, question asking during consultation, anxiety, and information recall). Methods Patients from a multidisciplinary outpatient clinic (N=232) viewed a mode-tailored or nontailored website as preparation before their hospital consultations to discuss diagnosis and treatment. Data were collected before (T1), during (T2), and after (T3) visitation. Website experience outcomes were assessed with questionnaires (T1). Patients’ question asking was coded from videotaped consultations, and anxiety was assessed through a questionnaire (T2). Telephone interviews were conducted to assess knowledge acquired from the website before (T1) and after consultation (T3), and information recall from the consultation (T3). Results The preparatory website was well used across all conditions (mean 34 min). Younger patients viewing the mode-tailored website were more satisfied before consultation (P=.02) and reported lower anxiety after consultation (P=.046; vs text only). This pattern was not found in older patients. Mode tailoring yielded no other significant differences in patient outcomes. Regression analyses showed that website involvement (beta=.15; P=.03) and, to a lesser extent, website satisfaction (beta=.15; P=.05) positively associated with knowledge before consultation (T1). In turn, higher knowledge before consultation (beta=.39; P<.001), together with time on the website (beta=.21; P=.002; T1), predicted information recall from consultations (T3). Patients with higher knowledge before consultation (T1) also reported higher knowledge from the website afterward (T3; beta=.22; P=.003). Conclusions Offering preparatory online information before consultations benefits information processing and patient outcomes of both younger and older newly diagnosed patients with cancer. Younger patients benefit even more when information is offered in a mode-tailored manner. We discuss the theoretical, methodological, and practical implications for patient-provider communication research in an electronic health era. Clinical Trial Netherlands Trial Register NTR5904; https://www.trialregister.nl/trial/5750

Communication about comorbidities among 527 older patients with advanced cancer and their oncologists and caregivers: A multisite cluster-randomized controlled trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12040-12040
Author(s):  
Amber Kleckner ◽  
Nikesha Gilmore ◽  
Elizabeth Belcher ◽  
Allison Magnuson ◽  
Richard Francis Dunne ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Advanced Cancer ◽  
Older Patients ◽  
Controlled Trial ◽  
Random Effect ◽  
Clinic Visit ◽  
Care Physician ◽  
Older Americans ◽  
Cluster Randomized ◽  
Management Recommendations

12040 Background: Older patients with advanced cancer often have comorbidities that increase the risk of toxicity from neoplastic therapy but are not always considered in treatment planning. We assessed the utility of a geriatric assessment (GA) intervention to increase the number and quality of discussions about comorbidities among oncologists, older patients, and caregivers. Methods: This multi-site trial enrolled patients who were ≥70 years, had advanced solid tumors or lymphoma, had ≥1 GA impairment, and who were considering or receiving cancer treatment. All patients received the GA and completed an Older Americans Resources and Services Comorbidity survey, which evaluated 15 conditions and interference with activities (clinical impairment = ≥3 comorbidities or ≥1 highly interfering). Oncology practices were randomized to intervention (GA with a summary with management recommendations provided to oncologists) or usual care (GA only). The clinic visit after GA was audio-recorded, transcribed, and coded for GA topics including comorbidity. Generalized linear mixed models adjusting for site (random effect) were used to assess the effect of the intervention. Results: Patients (n=527 evaluable, 76.6±5.2 years, 49% female) and oncologists (n=131, 63 in intervention) were enrolled from 31 sites. In total, 94.5% of patients had ≥1 comorbidity with an average of 3.2±1.9; 64% were clinically impaired by comorbidity (p=0.76 between arms). The intervention arm had twice the number of conversations about comorbidities (1.02 vs. 0.52 conversations per patient, difference 0.50, 95% CI 0.18-0.81, p=0.004) and conversations were more likely to be initiated by the oncologist (p<0.001, Table). Moreover, among patients who had conversations about comorbidities, more patients in the intervention arm had discussions specifically addressing comorbidities (e.g., cancer treatment modification, communication with the primary care physician; 24.3% vs. 7.5%, p=0.003). Conclusions: Providing oncologists with a GA summary and recommendations encouraged them to engage in more discussions about their patients’ comorbidities with the goal of addressing interactions between comorbidities, cancer, and its treatments. Funds: PCORI CD4634, NCI UG1CA189961 Clinical trial information: NCT02107443 . [Table: see text]

Aging, Community-Based Employment, Mobility Impairment, and Retirement: National Core Indicators–Adult Consumer Survey Data

2019 ◽  
Vol 44 (4) ◽  
pp. 251-266 ◽  
Author(s):  
Roger J. Stancliffe ◽  
Kelly M. Nye-Lengerman ◽  
Julie E. D. Kramme
Keyword(s):  
Age Groups ◽  
Secondary Analysis ◽  
Age Group ◽  
Consumer Survey ◽  
Mobility Limitations ◽  
Mobility Impairment ◽  
Community Based ◽  
Support Person ◽  
Age Related ◽  
Work Tasks

Little is known about how, when, or why individuals with intellectual and developmental disabilities (IDD) retire. Recognizing the changing needs of older adults with IDD is critical to support person-driven services and development of best practices in aging transitions. Using secondary analysis of the 2016 to 2017 National Core Indicators–Adult Consumer Survey (NCI-ACS) data for adults with IDD, we examined the relation between independent mobility (i.e., without aids), age group, level of intellectual disability, and type of employment/activity program, with a focus on mobility and community-based employment in older age groups. There was an overall age-related decline in mobility, but the prevalence of mobility impairment by age group was related to employment type. The percentage who were independently mobile was highest for community employment in every age group. The percentage of individuals by age group in community employment fell significantly from middle age onward, suggesting some former community-based workers had retired. There was no significant age-related difference in the percentage in facility-based employment across these age groups. Mobility limitations may be a barrier to obtaining or retaining community-based employment. Age-related mobility impairment may be associated with premature retirement, and could affect travel to and from work, undertaking work tasks, or both. Closer examination is needed of aging, community employment, and age-related mobility limitations to understand the specific causes of these effects on employment and identify supports and accommodations.

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