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

加强患有阿尔茨海默病或相关痴呆症的老年人面临癌症管理决策时关于认知的三元沟通

• 批准号: 10617370
• 负责人: Allison Marian Magnuson
• 金额: $ 50.07万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10617370
• 关键词: Acceleration; Advanced Malignant Neoplasm; Aging; Alzheimer' s disease diagnosis; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Anxiety; Behavioral; Benefits and Risks; Biometry; Cancer Patient; Caregivers; Caring; Climate; Clinical Oncology; Cluster randomized trial; Cognition; Cognitive; Communication; Communication Tools; Community Clinical Oncology Program; Complex; Cues; Data; Decision Making; Dementia; Depressed mood; Diagnosis; Elderly; Enrollment; Ensure; Equilibrium; Focus Groups; Geriatric Assessment; Goals; Healthcare; Impaired cognition; Intervention; Knowledge; Malignant Neoplasms; Measures; Medical; Methods; Morbidity - disease rate; Nature; Oncologist; Oncology; Outcome; Palliative Care; Patient-Focused Outcomes; Patients; Perception; Personal Satisfaction; Physicians; Population; Population Intervention; Process; Qualifying; Quality of life; Questionnaires; Randomized; Recommendation; Regrets; Research; Science; Symptoms; Training; Universities; behavioral neurology; cancer care; cancer clinical trial; cancer therapy; clinical diagnosis; clinical encounter; efficacy evaluation; experience; improved; individual patient; innovation; mortality; multidisciplinary; older patient; phase 3 study; post intervention; preference; primary outcome; programs; response; secondary analysis; side effect; skills; therapy development; tool; treatment as usual

Project Summary: The overarching goal of this proposal, submitted in response to RFA-AG-22-020, is to adapt an existing communication tool developed by our team for use in patients with Alzheimer’s Disease or Related Dementias (ADRD) and their care partners, and to evaluate if this tool can enhance communication about cognition in the context of a cancer management decision. This proposal is important because approximately 7% of older adults diagnosed with cancer have pre-existing dementia. For older adults with ADRD and cancer, medical decision making is more complex, and integrates information about the risks and benefits of potential interventions in the context of the dual diagnoses. Limited data are available to guide the “best” approach and thus, relies on discussions about the risks and benefits of options in the context of patient and care partner goals and preferences. Unfortunately, there is no standard approach among oncology clinicians as to how to discuss cognition in the context of a cancer management decision for patients with pre- existing ADRD and their care partners. Preliminary research by the PI (Magnuson) and team suggest that cognitive impairment is prevalent in older patients with cancer and that a geriatric assessment-based communication tool can facilitate conversations about aging-related conditions, such as cognition, with older patients and their care partners. However, the intervention was not tested in patients with ADRD and did not address patient and care partner concerns about cognition in the context of cancer. Adapting this tool for patients with ADRD (adapted tool called “COACH-Cog”) may improve both care partner and patient outcomes through greater acknowledgement and support of cognitive concerns and cognitive-related goals, thereby improving goal concordant care. COACH-Cog adaptations will include: 1) brief, focused training for oncology clinicians about ADRD in the context of cancer and communication training to navigate the triadic nature of these conversations, thereby enhancing oncology clinician knowledge and supporting their decision processes; and 2) care partner and patient Communication Coaching and Question Prompt List providing knowledge, skills, and behavioral cueing for discussing their cognitive concerns and cognitive-related goals with oncology clinicians. Focus groups with key stakeholders will guide the adaptation. Subsequently, we propose to conduct a pilot, Stage I RCT (cluster randomized at physician) with older adults with a clinical diagnosis of ADRD and their care partners (N=130 dyads) to evaluate the preliminary efficacy of COACH-Cog on care partner and patient autonomy support, care partner well-being, and goal concordance in outcomes at 3 months. Our uniquely qualified, multidisciplinary team includes expertise in geriatric oncology, cognition, behavioral neurology, intervention development, communication science, biostatistics, palliative care, and care partner research. This innovative proposal will develop a pragmatic tool for improving communication about cognition in the context of cancer treatment decision making for patients with ADRD and their care partners.

项目摘要：根据RFA-AG-22-020号文件提交的这项提案的总体目标是 调整我们团队开发的现有通信工具，用于阿尔茨海默病患者或 相关痴呆症(ADRD)及其护理伙伴，并评估该工具是否可以加强沟通 关于癌症管理决策背景下的认知。这项建议很重要，因为 在被诊断为癌症的老年人中，约有7%的人已经患有痴呆症。对于老年人来说，有 ADRD和癌症，医疗决策更加复杂，并整合了有关风险和 双重诊断背景下潜在干预措施的益处。有限的数据可以用来指导 “最佳”方法，因此，依赖于在患者情况下对选项的风险和好处的讨论 并关心合作伙伴的目标和偏好。不幸的是，在肿瘤学中没有标准的方法。 临床医生关于如何在癌症治疗决策的背景下讨论对先证者的认知 现有的ADRD及其护理合作伙伴。PI(Magnuson)和团队的初步研究表明 认知障碍在老年癌症患者中很普遍，基于老年评估 交流工具可以促进与老年人进行关于衰老相关疾病的对话，如认知 病人和他们的护理伙伴。然而，该干预措施没有在ADRD患者身上进行测试，也没有 解决患者和护理伙伴对癌症背景下认知的担忧。使此工具适用于 ADRD患者(改编的工具称为“Coach-Cog”)可能会改善护理伙伴和患者的预后 通过更多地承认和支持认知关切和与认知有关的目标，从而 提高目标协调性护理水平。Coach-Cog适应将包括：1)针对肿瘤学的简短、重点培训 临床医生在癌症和沟通培训的背景下了解ADRD，以驾驭 这些对话，从而增强肿瘤临床医生的知识，并支持他们的决策过程； 和2)护理伙伴和患者沟通辅导和提供知识的问题提示表， 技能和行为线索，用于与肿瘤学讨论他们的认知关切和认知相关目标 临床医生。由主要利益攸关方组成的重点小组将指导适应工作。随后，我们建议进行 一项试点的I期随机对照试验(在医生处随机分组)，对象为临床诊断为ADRD的老年人和 他们的护理伙伴(N=130对)，以评估Coach-Cog对护理伙伴和 3个月后患者自主支持、护理伙伴幸福感和目标一致性。我们的 独一无二的合格多学科团队包括老年肿瘤学、认知、行为方面的专业知识 神经学、干预发展、通信科学、生物统计学、姑息治疗和护理伙伴 研究。这一创新的建议将开发一种实用的工具，用于改善关于认知的沟通 在癌症治疗决策的背景下，ADRD患者和他们的护理伙伴。