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

University of Rochester300 enrolled

Overview

Building upon prior work, the investigator team developed a communication intervention for older adults with ADRD who are considering a decision about cancer management (adapted intervention: COACH-Cog). The investigators hypothesize that for patients with dual diagnoses of ADRD and cancer, COACH-Cog will increase autonomy support of care partners and patients in the decision-making process, leading to greater acknowledgement and support of cognitive concerns and cognitive-related goals, thereby improving goal concordant care. The investigators are conducting a pilot randomized controlled trial (RCT; cluster randomized by physician) including approximately 45 oncology clinicians and 130 patient/care partner dyads evaluating the effect of COACH-Cog on care partner and patient autonomy support, care partner well-being, goal-concordance, and communication.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

300

Conditions

Cancer Dementia

Interventions

Oncology clinician intervention components: 1) a brief training video (completed once during the duration of the study following enrollment and randomization), 2) For each patient/care partner dyad that is subsequently enrolled onto the study that the clinician cares for, the oncology clinician will receive the results of the patient's GA with targeted management recommendations for identified GA domain impairments Patient/Care partner dyad intervention components: 1) Care partners (and patients if able) will participate in a one-time communication coaching session; 2) Patient GA results with management recommendations to consider discussing with the oncology team will be provided to care partners and patients.

Eligibility

Sex: ALLMin age: 65 Years

Medical Language ↔ Plain English

PATIENTS: Patient Inclusion Criteria: 1. Be age 65 or older 2. Have a clinical diagnosis of Alzheimer's disease or related dementia (ADRD \[Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia, or dementia of unknown subtype\]) 3. Have a clinical diagnosis of cancer (any type or stage) 4. Anticipate a potential decision about cancer-related management, as confirmed by the patient's primary medical oncology clinician. 5. Have a care partner willing and able to participate in the study 6. Are able to read and understand English. The communication coaching session will be delivered in English, thus necessitating this requirement. 7. Be able to provide informed consent (as measured by UBACC) or have a Legally Authorized Representative to provide informed consent Patient Exclusion Criteria: Patient exclusion criteria: None CARE PARTNER: Care partner inclusion criteria: 1. Age 18 or over 2. Able to read and understand spoken English 3. Able to provide informed consent Care partner exclusion criteria: None ONCOLOGY CLINICIAN: Oncology clinician inclusion criteria: 1. Oncology clinicians affiliated with the Wilmot Cancer Institute 2. Do not intend to move or retire within the next 2 years. Oncology clinician exclusion criteria: None

Outcomes

Primary Outcomes

Care Partner: Health Care Climate Questionnaire (HCCQ)

Care Partner autonomy support; score range: 6-42; higher score is better.

Time frame: 4-weeks post oncology clinical encounter

Secondary Outcomes

Zarit Caregiver Burden Assessment

4-Item Measure Care partner well-being: Caregiver burden; total score range 0-16; Higher score is worse burden.