Pathways to Advance Targeted and Helpful Serious Illness Conversations (PATH-SIC)

Dana-Farber Cancer Institute

Status: Active, not recruiting

Conditions: Breast Cancer; Gastrointestinal Cancer; Genitourinary Cancer; Gynecologic Cancer; Thoracic Cancer

Treatments: Other: Clinician Nudge Email; Other: Patient Nudge Letter and Share questionaire

Study type: Interventional

Funder types: Other

Identifiers

NCT05629065

22-501

Details and patient eligibility

About

The purpose of this study is to increase serious illness conversations (SICs) about patients goals and preferences regarding their healthcare between patients with cancer and their oncology clinicians and improved care provided near the end of life.

Full description

The objective of this study is to implement an intervention in a pragmatic randomized controlled trial that uses cancer treatment pathways data to identify patients appropriate for serious illness conversations (SICs) and applies "nudges" to patients and their oncology clinicians to increase SICs and improve end of life (EOL) outcomes.

Identified participants and clinicians will be randomized into 1 or 4 groups.

• Nudge to patient and clinician
• Nudge to patient only
• Nudge to clinician only
• No nudge.

The expected enrollment is approximately 800 participants.

Enrollment: 800 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients who are aged 18 years or older, reach one of the poor prognosis nodes identified and have an upcoming appointment at one of the following Dana Farber Cancer Institute oncology clinics (including Longwood and Chestnut Hill locations)
• Breast Oncology Clinic
• Gastrointestinal Oncology Clinic
• Genitourinary Oncology Clinic
• Gynecologic Oncology Clinic
• Thoracic Oncology Clinic

Exclusion criteria

• Patients with an SIC documented in the Advance Care Planning module of the electronic health record in the 6 months prior to reaching a poor prognosis node
• Patients who have previously been randomized in this trial (e.g., the patient is encountering a poor-prognosis node for the second time during the trial period)

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Single Blind

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800 participants in 4 patient groups

Both patient and clinician receive a nudge

Experimental group

Description:

* Patient nudge consists of a letter and SHARE questionnaire * Clinician "nudge" email encouraging discussion to initiate discussion on SIC

Treatment:

Other: Patient Nudge Letter and Share questionaire

Other: Clinician Nudge Email

Neither the patient nor clinician receive a nudge

No Intervention group

Description:

Standard Care

Patient receives a nudge but not the clinician

Experimental group

Description:

-Patient nudge consists of a letter and SHARE questionnaire

Treatment:

Other: Patient Nudge Letter and Share questionaire

Clinician receives a nudge but not the patient

Experimental group

Description:

-Clinician "nudge" email encouraging discussion to initiate discussion on SIC

Treatment:

Other: Clinician Nudge Email