Communicating the Gist of Prognosis: Giving Information Simply and Transparently ("GIST") in Advanced Cancer

项目摘要/摘要 尽管最近癌症治疗取得了进展，但疾病仍然会有进展的时候，而且 可以肯定的是，患者还能活几个月，而不是几年。尽管肿瘤学家可以可靠地 预测患者何时还有几个月的生命，71%的晚期癌症患者报告希望获得预后 信息(83%的人认为它极其重要)，只有17.6%的患者从 Death报告了与他们的肿瘤学家的预后讨论。此外，这些患者中只有5%的人有准确的 预见性理解。不仅知情的、以患者为中心的、共享的决策依赖于患者的 对自己的预后有基本的了解，但患者对预后的了解与 更好的临终结局(例如，减少负担、无益的护理；更多的姑息和价值- 始终如一的护理)。因此，我们之前的工作突出了对一种通信技术的需求，这种技术将证明 肿瘤学家可以接受，这促进了患者对预后的理解。为了满足这一需求，我们 开发了“简单而透明地提供信息”(GIST)，Oncolo-GIST干预--手册 肿瘤学家沟通干预，通过关注4个方面简化了如何传递预后信息 基本步骤：1)提供扫描信息，2)告知预后，3)敏感地制定战略，4) 透明地询问病人听到了什么。将测试Oncolo-GIST方法的3个具体目标： U特定目标#1：U将从利益相关者/关键信息者(n=10)那里获得关于Oncolo-GIST 1.0版的反馈 失去照顾者；n=10名肿瘤临床医生)使用改进的Delphi方法。具体目标2：你将 在10例晚期癌症的开放试验中确定Oncolo-GIST 1.0版的可行性和可接受性 病人。U特定目标3：U将确定患者(n=25)是否随机与肿瘤学家会面 被分配到Oncolo-GIST 2.0版培训的患者比接受常规护理的患者(n=25)更有可能 对预后有更好的了解(例如，报告他们可能还能活几个月)，我们的主要结果是。 对患者的潜在影响：a)参与ACP，b)生活质量，接受：c)重症监护，d)姑息治疗 护理，e)价值一致的临终护理，以及肿瘤学家报告的：f)对预后讨论的满意度 和g)与患者的治疗联盟，将被探索。结果将导致Oncolo-GIST的改进 干预，提示其临床可行性和可接受性，以及Oncolo-GIST干预是否 促进患者对预后的理解和假想的“下游”效应(例如，不那么密集， 更多的姑息治疗，更好的患者生活质量)。积极的结果将支持未来的Oncolo测试- GIST干预在晚期癌症患者多部位R01随机对照试验中的应用 这一“要点”方法在知情的临终决策方面的适用性。

Project Summary/Abstract Despite recent advances in cancer treatments, there still comes a time when the disease progresses, and patients can reliably be expected to have months, but not years, left to live. Although oncologists can reliably predict when patients have months to live, and 71% of advanced cancer patients report wanting prognostic information (with 83% deeming it extremely important), only 17.6% of patients a median of 5 months from death reported a prognostic discussion with their oncologist. Moreover, only 5% of these patients had accurate prognostic understanding. Not only does informed, patient-centered, shared decision-making rely on patients' having a basic understanding of their prognosis, but patients' prognostic understanding has been linked to significantly better end-of-life outcomes (e.g., less burdensome, unbeneficial care; more palliative and value- consistent care). Our prior work thus highlights the need for a communication technique that will prove acceptable to oncologists and that promotes patients' prognostic understanding. To address this need, we developed the “Giving Information Simply &Transparently” (GIST), Oncolo-GIST intervention -- a manualized oncologist communication intervention that simplifies how to impart prognostic information by focusing on 4 basic steps: 1) Giving scan information, 2) Informing prognosis, 3) Strategizing sensitively, and 4) Transparently asking what patients heard. 3 specific aims of the Oncolo-GIST approach will be tested: USpecific Aim #1:U will obtain feedback on Oncolo-GIST Version 1.0 from stakeholders/key informants (n=10 bereaved caregivers; n=10 oncology clinicians) using a modified Delphi approach. USpecific Aim #2:U will determine feasibility and acceptability of Oncolo-GIST Version 1.0 in an open trial of 10 advanced cancer patients. USpecific Aim #3:U will determine whether patients (n=25) meeting with an oncologist randomly assigned to training in Oncolo-GIST Version 2.0 are more likely than patients receiving usual care (n=25) to have better prognostic understanding (e.g., report they likely have months to live), our Uprimary outcomeU. Potential effects on patient: a) engagement in ACP, b) quality of life, receipt of: c) intensive care, d) palliative care, e) value-consistent end-of-life care, and oncologist-reported: f) satisfaction with prognostic discussions and g) therapeutic alliance with patients, will be explored. Results will lead to refinements in the Oncolo-GIST intervention, suggest its clinical feasibility and acceptability, and whether the Oncolo-GIST intervention promotes patients' prognostic understanding and hypothesized "downstream" effects (e.g., less intensive, more palliative care, better patient quality of life). Positive results will support the future testing of the Oncolo- GIST intervention in a multi-site R01 RCT of advanced cancer patients and suggest the potential broader applicability of this "gist" approach to informed end-of-life decision-making.