The purpose of this study is to increase serious illness conversations (SICs) about patients goals and preferences regarding their healthcare between patients with cancer and their oncology clinicians and improved care provided near the end of life.
The objective of this study is to implement an intervention in a pragmatic randomized controlled trial that uses cancer treatment pathways data to identify patients appropriate for serious illness conversations (SICs) and applies "nudges" to patients and their oncology clinicians to increase SICs and improve end of life (EOL) outcomes. Identified participants and clinicians will be randomized into 1 or 4 groups. * Nudge to patient and clinician * Nudge to patient only * Nudge to clinician only * No nudge. The expected enrollment is approximately 800 participants.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
800
-Clinician "nudge" email encouraging discussion to initiate discussion on SIC at next visit
Involves patient nudge consists of a letter and SHARE questionnaire \- patient nudge is a letter and a SHARE questionnaire encourages the participant to complete the SHARE questionnaire, which asks questions about the participants goals and preferences around cancer care, and discuss the questionnaire with their oncology clinician at the next visit.
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Proportion of patients with an SIC at 60 days for arm 1 (patient +clinician nudge) vs arm 2 (no nudge).
The numerator includes patients with any SIC documentation extracted from the Advanced Care Planning module between the date of the poor prognosis node and 60 days. The denominator is all patients randomized to the applicable study arm.
Time frame: up to 60 days after reaching the poor prognosis node
Proportion of patients with an SIC at 60 days, comparison of all 4 study arms
Same as the primary outcome
Time frame: up to 60 days after reaching the poor prognosis node
Time from SIC to death among decedents
Time from SIC to death among decedents
Time frame: randomization up to 1 year
Receipt of chemotherapy in last 14 days of life
Whether or not the patient received chemotherapy in the last 14 days of life, among decedents
Time frame: randomization up to 1 year
ED visits in the last 30 days of life
Number of ED visits in the last 30 days of life, among decedents
Time frame: randomization up to 1 year
Hospitalization in last 30 days of life
Hospitalization in the last 30 days of life, among decedents
Time frame: randomization up to 1 year
Median length of hospitalization
Median length of last hospitalization, in days among decedents
Time frame: randomization up to 1 year
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ICU utilization in last 30 days of life
ICU hospitalization in the last 30 days of life, among decedents
Time frame: randomization up to 1 year
Death in an acute care facility
Presence or absence of death in an acute care facility like a hospital or emergency room
Time frame: randomization up to 1 year
Death in the ICU
Whether or not death occurred in an ICU
Time frame: randomization up to 1 year
Hospice enrollment at death
Whether or not the patient was enrolled in hospice on the day of death
Time frame: randomization up to 1 year
Enrolled < 4 days in hospice at death
Whether or not the patient was enrolled in hospice for less than 4 days on the day of death
Time frame: randomization up to 1 year
Patient preferences
Patient responses on SHARE questionnaire
Time frame: Up to 60 days after randomization