Grant Details
Grant Number: |
1R21CA224874-01A1 Interpret this number |
Primary Investigator: |
Shen, Megan |
Organization: |
Weill Medical Coll Of Cornell Univ |
Project Title: |
A Communication-Based Intervention for Advanced Cancer Patient-Caregiver Dyads to Increase Engagement in Advance Care Planning and Reduce Caregiver Burden |
Fiscal Year: |
2018 |
Abstract
PROJECT SUMMARY
Accurate prognostic understanding is a critical predictor of patients' engagement in advance care planning
(ACP) and receipt of less futile, aggressive care at the end of life. However, approximately half of advanced
cancer patients do not understand the terminal nature of their illness. Caregivers play an integral role in
patients' care and decision-making at the end of life, yet few interventions include them. Drs. Shen and
Trevino's pilot work, in collaboration with their Co-Investigators Drs. Prigerson and Maciejewski, suggests that
improving both patient and caregiver prognostic understanding surrounding the patient's terminal status and
estimated life expectancy is associated with higher rates of engagement in ACP. Based on this pilot work and
the important role of caregivers in end-of life (EOL) cancer care, this study aims to develop a communication-
based intervention to improve advanced cancer patients' and caregivers' prognostic understanding. The goals
of this study are to: (1) develop a communication-based intervention to improve advanced cancer patients' and
caregivers' prognostic understanding using communication strategies (e.g., acknowledgment, validation of
fears) and distress management techniques (e.g., deep breathing, muscle relaxation); (2) evaluate the
feasibility and acceptability of the intervention among advanced cancer patients and their caregivers; and (3)
test the preliminary efficacy of the intervention on patients' and caregivers' prognostic understanding (primary
outcome); completion of DNR order, living will, and health care proxy; psychological distress; communication
quality; caregiver burden; and healthcare utilization (secondary outcomes). To meet these goals, we will collect
feedback from advanced cancer patients and their caregivers (n=10 dyads) and psychosocial experts (n=10) to
improve and refine the intervention. Next, we will pilot test the intervention with n=30 patient-caregiver dyads
and assess outcomes at baseline, post-intervention, and three months later to determine the feasibility,
acceptability, and preliminary efficacy of the intervention on improving engagement in ACP and
communication, reducing distress and caregiver burden, improving rates of goal-concordant care, and reducing
rates of futile aggressive care. These results will inform a future NIH R01 application to conduct a large-scale
randomized clinical trial (RCT) of intervention efficacy. Grounded in established theories of inhibitory learning
and social-cognitive processing, the present study takes the novel approach of integrating communication and
distress management techniques to improve patients' and caregivers' ability to discuss difficult EOL topics
while managing the distress associated with these topics. It is expected that these results will form a strong
foundation for a program of research focused on integrating caregivers into interventions targeting advanced
cancer patients as a novel and innovative way to improve engagement in ACP, increase rates of goal-
concordant care, and reduce receipt of futile, aggressive EOL care.
Publications
Advance care planning in an interracial dyad: Case illustration of an intervention to improve engagement in end-of-life care planning.
Authors: McConnell K.M.
, Rogers M.
, Prigerson H.G.
, Maciejewski P.K.
, Daly B.
, Adelman R.
, Shen M.
.
Source: Psycho-oncology, 2023 Aug; 32(8), p. 1306-1312.
EPub date: 2023-06-19 00:00:00.0.
PMID: 37334501
Related Citations
A communication intervention to improve prognostic understanding and engagement in advance care planning among diverse advanced cancer patient-caregiver dyads: A pilot study.
Authors: Shen M.J.
, Prigerson H.G.
, Maciejewski P.K.
, Daly B.
, Adelman R.
, McConnell Trevino K.M.
.
Source: Palliative & Supportive Care, 2023-08-01 00:00:00.0; , p. 1-9.
EPub date: 2023-08-01 00:00:00.0.
PMID: 37526150
Related Citations
Cultural adaptation of meaning-centered psychotherapy for latino families: a protocol.
Authors: Torres Blasco N.
, Costas Muñiz R.
, Zamore C.
, Porter L.
, Claros M.
, Bernal G.
, Shen M.J.
, Breitbart W.
, Castro E.M.
.
Source: Bmj Open, 2022-04-04 00:00:00.0; 12(4), p. e045487.
EPub date: 2022-04-04 00:00:00.0.
PMID: 35379609
Related Citations