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A communication intervention to improve prognostic understanding and engagement in advance care planning among diverse advanced cancer patient–caregiver dyads: A pilot study

Published online by Cambridge University Press:  01 August 2023

Megan J. Shen Open the ORCID record for Megan J. Shen [Opens in a new window] ,
Holly G. Prigerson ,
Paul K. Maciejewski ,
Bobby Daly ,
Ronald Adelman  and
Kelly M. McConnell Trevino
Megan J. Shen*
Affiliation:
Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, WA, USA
Holly G. Prigerson
Affiliation:
Department of Medicine, Weill Cornell Medical College, New York, NY, USA
Paul K. Maciejewski
Affiliation:
Department of Radiology, Weill Cornell Medical College, New York, NY, USA
Bobby Daly
Affiliation:
Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Ronald Adelman
Affiliation:
Department of Medicine, Weill Cornell Medical College, New York, NY, USA
Kelly M. McConnell Trevino
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
*
Corresponding author: Megan J. Shen; Email: mshen2@fredhutch.org
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Abstract

Objectives

Accurate prognostic understanding among patients with advanced cancer and their caregivers is associated with greater engagement in advance care planning (ACP) and receipt of goal-concordant care. Poor prognostic understanding is more prevalent among racial and ethnic minority patients. The purpose of this study was to examine the feasibility, acceptability, and impact of a patient–caregiver communication-based intervention to improve prognostic understanding, engagement in ACP, and completion of advance directives among a racially and ethnically diverse, urban sample of patients and their caregivers.

Methods

Patients with advanced cancer and their caregivers (n = 22 dyads) completed assessments of prognostic understanding, engagement in ACP, and completion of advance directives at baseline and post-intervention, Talking About Cancer (TAC). TAC is a 7-session intervention delivered remotely by licensed social workers that includes distress management and communication skills, review of prognosis, and information on ACP.

Results

TAC met a priori benchmarks for feasibility, acceptability, and fidelity. Prognostic understanding and engagement in ACP did not change over time. However, patients showed increases in completion of advance directives.

Significance of results

TAC was feasible, acceptable, and delivered with high fidelity. Involvement of caregivers in TAC may provide added layers of support to patients facing advanced cancer diagnoses, especially among racial and ethnic minorities. Trends indicated greater completion of advance directives but not in prognostic understanding or engagement in ACP. Future research is needed to optimize the intervention to improve acceptability, tailor to diverse patient populations, and examine the efficacy of TAC in a randomized controlled trial.

Keywords

CancerAdvance care planningCommunicationCaregiver
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 1 , February 2024 , pp. 10 - 18
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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