Grant Number:	1R01CA288318-01A1 Interpret this number
Primary Investigator:	Loh, Kah Poh
Organization:	University Of Rochester
Project Title:	A Decisional Intervention for Older Adults with Acute Myeloid Leukemia and Their Caregivers
Fiscal Year:	2025

Therapeutic advances have allowed more adults aged ≥60 years with acute myeloid leukemia (AML) to receive life-prolonging treatments. Nevertheless, the disease remains generally incurable with a two-year overall survival of <20%. In contrast to other cancers, the onset of AML is often sudden, high-risk treatment decisions must be made quickly, and survival is often compromised due to aging-related conditions (e.g., functional impairments). In addition, we and others have demonstrated that up to 78% of older adults with AML and their caregivers experience significant psychological distress. Distress is associated with poor quality of life, increased healthcare utilization, and increased mortality. Shared decision making (SDM) can reduce patient and caregiver distress and is essential to achieve goal-concordant care. Therefore, interventions to improve distress and optimize SDM in older adults with AML and their caregivers are needed. Critical elements of SDM include recognizing that a decision is needed, understanding options, and incorporating patient values into the decision. To achieve SDM, patients must be knowledgeable about their disease, treatment options, and prognosis, and their values must be incorporated into treatment decisions. In partnership with our patient and caregiver advisory board, we have tested the feasibility of a multilevel decisional intervention (UR-GOAL) that addresses critical elements of SDM for older adults with AML. UR-GOAL targets patients (caregivers) and oncologists: 1) Patients view an educational video about AML diagnosis, treatment, and prognosis; complete the BWS value clarification process; and review a summary report of their values with tailored question prompts and resources; 2) Caregivers (if available) view the same educational video and receive the same summary report as patients; 3) Oncologists review a summary report of the patient’s aging-related conditions, perception of prognosis, and values. Patients (caregivers) and oncologists then meet to discuss aging-related conditions, prognosis, and patient values during treatment decision making clinical visits. In our pilot studies, we demonstrated that it was feasible to recruit this population. Preliminary findings showed that compared to those receiving usual care, patient and caregiver randomized to UR-GOAL experienced lower distress at 1 month after a treatment decision was reached. We propose a multicenter randomized controlled trial to evaluate the efficacy of UR-GOAL compared to an attention control for improving outcomes. We will recruit 300 older adults with newly diagnosed AML, their caregivers if available, and oncologists from four institutions. We aim to assess the efficacy of UR-GOAL versus an attention control for: 1) reducing patient distress; and 2) improving objective SDM, patient-perceived SDM, and decisional conflict. We will also assess other patient (perception of prognosis, goal-concordant care), caregiver (distress, perception of prognosis), and healthcare (emergency department visits and hospitalization in the last 30 days of life) outcomes. If successful, the intervention has the potential to be extended to other cancer populations and diseases.




Protocol of a decisional intervention for older adults with newly diagnosed acute myeloid leukemia and their caregivers: UR-GOAL 3.
Authors: Loh K.P. , Ng Q.M.R. , Mohile S.G. , Norton S. , Epstein R.M. , Sohn M.B. , Richardson D. , Jamy O. , Hedjri S.M. , Blumberg R. , et al. .
Source: Journal Of Geriatric Oncology, 2025 Mar; 16(2), p. 102187.
EPub date: 2025-01-18 00:00:00.0.
PMID: 39828449
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