||5R01CA262039-02 Interpret this number
||University Of Alabama At Birmingham
||Decision Support Training for Advanced Cancer Family Caregivers: the Cascade Factorial Trial
A priority in oncology and palliative care is preparing the 3.2 million U.S. family caregivers of persons with
cancer to effectively support patients in health-related decision-making from diagnosis to the end of life,
particularly in underserved settings. Over 70% of patients with cancer involve family in health decisions,
including choices about treatments, surgery, location of care, accessing palliative care, and many others.
Patients making these decisions with unprepared family caregivers may experience inadequate family decision
support leading to heightened distress and receipt of care/treatments inconsistent with their values and
preferences. This in turn may increase distress for family caregivers. There is a critical need to train cancer
family caregivers to effectively support patient decision-making; however, few palliative care interventions have
been tested to enhance caregiver skills in providing decision support. We have developed CASCADE (CAre
Supporters Coached to be Adept DEcision partners), a lay navigator-led, telehealth early palliative care
intervention to train advanced cancer caregivers how to effectively partner with patients in health decision-
making. Evolving out of our prior early palliative care caregiving interventions, decision support relevant
content for family caregivers includes principles of effective social support, communication, and Ottawa
Decision Guide training; however we do not know which of these components and component interactions
influences patient and caregiver decision-making outcomes. Traditional research approaches treat
interventions as “bundled” treatment packages, making it difficult to assess definitively which intervention
components can be reduced, eliminated, or replaced to improve efficiency. Hence, we propose a randomized
23 (2x2x2) factorial trial, the first such trial in oncology palliative care, using the Multiphase Optimization
Strategy (MOST) to test components of CASCADE in order to assemble an optimized, scalable version of the
intervention. 352 family caregivers of persons with newly-diagnosed advanced cancer will be randomized to
receive one or more palliative care lay navigator-delivered decision partnering training components, based on
the Ottawa Decision Support Framework and Social Support Effectiveness Theory: 1) psychoeducation on
social support effectiveness in decision support (1 vs. 3 sessions); 2) decision support communication training
(yes vs. no); and 3) Ottawa Decision Guide training (yes vs. no). We will determine CASCADE components
(main effects/interactions) that contribute meaningfully to patient and caregiver outcomes, including patient
healthcare utilization (Aim 1) and use those results to build a version of the CASCADE intervention that is
maximally effective and scalable (Aim 2). To maximize recruitment, we will recruit from two NCI-designated
comprehensive cancer centers in Birmingham, AL and Atlanta, GA. Using the innovative MOST framework will
yield a highly novel and cost effective version of CASCADE primed for confirmatory RCT testing, scalability,
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