The purpose of this study is to see whether patients with metastatic breast cancer, their caregivers, and their healthcare providers can improve in shared decision making (SDM) and preparedness around end of life (EOL) planning through participation in Reimagine's online Four Conversations™ program. The goal is to close clinical practice gaps and enhance the quality of care for patients with metastatic breast cancer through increased competence and performance of healthcare providers and healthcare systems.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
357
The online Four Conversations program consists of tutorial videos, printable documents, and live sessions with a counselor to educate subjects on shared decision making and care planning for those with advanced disease.
Duke University Medical Center
Durham, North Carolina, United States
Change in patient/caregiver and provider preparedness for decision making as measured by the Preparation for Decision Making Scale
The Preparation for Decision Making Scale is a reliable and validated self-reported measure of the patient/caregiver or provider's perception of how useful a decision support intervention is in preparing the respondent to communicate with others making a health decision. Items are summed and scored, then divided by 10; scores can be converted to a 0-100 scale. Higher scores indicate higher perceived level of preparation for decision making.
Time frame: Baseline, Week 4 (waitlisted control only), Post-Intervention (Week 4 or 8)
Change in patient/caregiver decision making self-efficacy as measured by the Decision Self-efficacy Scale
The Decision Self-efficacy Scale is a reliable and validated instrument that measures self-confidence or belief in one's abilities in decision making, including shared decision making (SDM). Items are summed, divided by 11, and multiplied by 25. Scores range from 0 to 100 (very confident).
Time frame: Baseline, Week 4 (waitlisted control only), Post-Intervention (Week 4 or 8)
Change in patient self-conflict as measured by the Decisional Conflict Scale
The Decisional Conflict scale is a reliable and validated measure of the state of uncertainty about a course of action. Items are summed, divided by 16, and multiplied by 25. Scores range from 0 to 100 (high decisional conflict).
Time frame: Baseline, Week 4 (waitlisted control only), Post-Intervention (Week 4 or 8)
Change in provider end of life (EOL) care knowledge as measured by revised City of Hope EOL Knowledge Assessment
The content of the City of Hope End of Life Knowledge Assessment was revised to reflect the program curriculum. Correctly answered questions will be awarded one point, summed, and a total score generated.
Time frame: Baseline, Post-Intervention (Week 4)
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Change in patient and caregiver quality of life (QOL) as measured by the PROMIS Global Scale
The PROMIS Global Scale is a reliable and validated measure of general perceptions of health. Items are predictive of care utilization and mortality. The scale produces two health scores: physical and mental. Items are summed and converted to t-scores.
Time frame: Baseline, Week 4 (waitlisted control only), Post-Intervention (Week 4 or 8)
Change in patient/caregiver and provider end of life (EOL) conversations as measured by EOL Conversations
The EOL Conversations are author-developed questionnaires incorporating items from the Survey on Advanced Care Planning Conversations. Points are totaled and summed.
Time frame: Baseline, Week 4 (waitlisted control only), Post-Intervention (Week 4 or 8)