Development and Pilot Testing of a Collaborative Agenda-Setting Intervention to Promote Patient-Centered Communication in Ovarian Cancer Care

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PROJECT SUMMARY / ABSTRACT Patients with advanced ovarian cancer experience a complex array of physical symptoms and bear a disproportionately high burden of psychological distress. Patient-centered communication (PCC) is associated with better health-related quality of life (HRQoL) in patients with cancer and is essential to high-quality gynecologic cancer care. However, few communication interventions have improved HRQoL in patients with cancer. One possible explanation is that most communication interventions have limited scalability. To date, no known intervention has aimed to assist patients with ovarian cancer and their clinicians to routinely engage in PCC. Without such an intervention, the potential for PCC to improve health outcomes may go unrealized. Another obstacle to developing interventions to promote PCC is that optimal assessment of PCC includes objective ratings of patient and clinician behavior. Investigators typically rely on trained coders to identify PCC behaviors during audio-recorded clinic visits. This resource-intensive approach lacks feasibility for studies with large samples. Novel methods for assessing PCC behaviors are needed to advance the field. Natural language processing (NLP) is approximately ten times faster than manual coding and may identify information that human coders miss. However, the feasibility of using NLP to assess PCC behaviors is unknown. The overall objective of the proposed research is to refine and pilot test a collaborative agenda-setting intervention (CASI) to facilitate PCC in ovarian cancer care. The specific aims of this project are to (1) assess the usability and acceptability of the CASI and identify barriers to its implementation; (2) assess the feasibility of a randomized controlled trial (RCT) comparing the CASI to usual care; and (3) assess the feasibility of using NLP to assess PCC behaviors. Data will be collected through think-aloud interviews, usability and acceptability surveys, and a two-arm, parallel-group pilot RCT. The proposed career development plan will prepare me to advance toward independence by (a) applying principles of implementation science to enhance intervention scalability; (b) gain experience designing, conducting, and analyzing and disseminating data resulting from randomized trials; (c) develop expertise in using NLP to analyze unstructured text; (d) strengthening skills in grantsmanship, scientific communication, and leadership; and (e) building a network of interdisciplinary mentors and collaborators. These objectives will be achieved through a combination of mentored research experiences; didactic training; and scientific meetings at Dana-Farber Cancer Institute, Harvard Medical School, and the Harvard School of Public Health. The proposed research and training plan relates directly to the mission of the National Institute of Nursing Research. This project will (a) pilot test an innovative health technology to improve HRQoL, (b) use a person- centered perspective to implement new models of care, and (c) train the nurse scientists of the 21st century.