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

项目总结/摘要 尽管最近在癌症治疗方面取得了进展，但疾病仍会发展， 患者可以可靠地预期剩下几个月而不是几年的寿命。尽管肿瘤学家可以可靠地 预测患者的生存时间，71%的晚期癌症患者报告希望预测 信息（83%的人认为这非常重要），只有17.6%的患者的中位数为5个月， 死亡报告与他们的肿瘤学家进行了预后讨论。此外，只有5%的患者有准确的 预后理解知情的、以患者为中心的、共享的决策不仅依赖于患者的 对他们的预后有一个基本的了解，但患者的预后理解与 显著更好的寿命结束结果（例如，更少的负担，无益的护理;更多的姑息和价值- 持续护理）。因此，我们先前的工作强调了对通信技术的需求， 肿瘤学家可以接受，并促进患者对预后的理解。为了满足这一需求，我们 开发了“简单而准确地提供信息”（GIST），肿瘤GIST干预--一种手动的 肿瘤学家沟通干预，简化了如何传递预后信息，重点是4 基本步骤：1）提供扫描信息，2）告知预后，3）敏感地制定策略，4） 询问患者听到了什么。将测试Oncolo-GIST方法的3个具体目标： U具体目标#1：U将从利益相关者/关键知情人处获得关于Oncol-GIST版本1.0的反馈（n=10 丧失亲人的照顾者; n=10名肿瘤学临床医生）使用改良的德尔菲方法。USpecific Aim #2：你会 在10例晚期癌症的开放试验中确定Oncolo-GIST版本1.0的可行性和可接受性 患者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 分配到Oncolo-GIST 2.0版培训的患者比接受常规治疗的患者（n=25）更有可能 具有更好的预后理解（例如，报告他们可能有几个月的生活），我们的主要结果。 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，和肿瘤学家报告：f）对预后讨论的满意度 及g）与病人的治疗联盟。结果将导致肿瘤GIST的改进 干预，表明其临床可行性和可接受性，以及是否肿瘤GIST干预 促进患者的预后理解和假设的“下游”效应（例如，强度较低， 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测试Oncolo- 在晚期癌症患者的多中心R 01 RCT中进行GIST干预，并提示潜在的更广泛的 这一“要点”方法对知情的寿命终了决策的适用性。

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.