||5R37CA246703-04 Interpret this number
||Fred Hutchinson Cancer Center
||Planning Advance Care Together (PACT) to Improve Engagement in Advance Care Planning Among Advanced Cancer Patients
Engagement in advance care planning (ACP), which includes having end-of-life (EoL) conversations and
completing advance directives (ADs) (e.g., living will, health care proxy), has been shown to improve the
quality of care and reduce suffering at the end of life. However, less than half of advanced cancer patients
engage in ACP or complete ADs. One commonly overlooked barrier to ACP engagement and AD completion is
a lack of acknowledgment that the majority of cancer patients report ACP as a social process in which they
want to engage multiple loved ones and family members in their decision-making process. Dr. Shen’s work, in
collaboration with her Co-Investigator Dr. Prigerson, suggests that patients frequently report involvement of
family members as a critical concern and need for engaging in ACP and that 70.7% report their EoL care
treatment preferences being shaped around concerns about their family members. Based on this pilot work
and prior work indicating a patient preference to engage in ACP as a social process, this study aims to develop
and pilot test a mobile application [Planning Advance Care Together (PACT)] designed to improve advanced
cancer patients’ and caregivers’ engagement in patients’ ACP, presence of ACP discussions, completion of
ADs, and receipt of goal-concordant care. The goals of this study are to: (1) refine and field-test a mobile
application intervention (PACT) using an iterative design approach, “Think Aloud” exercises, and usability
protocols; (2) evaluate the feasibility, acceptability, usability, satisfaction, and user engagement of the
intervention among advanced cancer patients and their caregivers; (3) test the preliminary efficacy of the
intervention on patients’ and caregivers’ level of engagement in ACP, documented ACP conversations, and
patients’ completion of ADs (primary outcomes); and patients’ and caregivers’ perceived social support and
family functioning as well as patients’ receipt of goal-concordant care (secondary outcomes); and (4) evaluate
process measures in a post-intervention interview. To meet these goals, we will collect feedback from
advanced cancer patients (n=10), caregivers (n=10), and providers (n=10) to improve and refine the
intervention prototype. Next, we will conduct iterative field-testing with two sets of patient-caregiver dyads
(n=15 per group) to refine the mobile application. Then, we will randomize n=100 patient-caregiver dyads to
the intervention group and n=100 dyads to the control group (usual care) and assess outcomes at baseline
and 3 and 6 months post-intervention to determine the feasibility, acceptability, usability, satisfaction, user
engagement, and preliminary efficacy of the intervention. Finally, we will conduct a brief post-intervention
interview with a subset of patients (n=15) and caregivers (n=15) to understand processes of using the PACT
application. Grounded in established theories of decision-making science, the proposed project takes the novel
approach of utilizing mobile health technology to integrate loved ones into patients’ ACP decision-making.
Latino advanced cancer patients' prognostic awareness and familial cultural influences on advance care planning engagement: a qualitative study.
Torres Blasco N.
, Rosario L.
, Shen M.J.
Palliative care and social practice, 2023; 17, p. 26323524231193038.