Goals of Care Discussions for Advanced Lung and Gastrointestinal Cancer
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: M.D. Anderson Cancer Center
Disqualifiers: Hospice, Comatose, Dementia, others
No Placebo Group
Trial Summary
What is the purpose of this trial?
To improve quality of life for participants with advanced cancer, support their families, and lower overall cost of care.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the treatment Goals of Care Discussion for advanced lung and gastrointestinal cancer?
Is it safe to participate in Goals of Care Discussions for cancer treatment?
How does the Goals of Care Discussions treatment differ from other treatments for advanced lung and gastrointestinal cancer?
The Goals of Care Discussions treatment is unique because it focuses on early conversations between patients and oncologists about care preferences and treatment goals, rather than a specific medical intervention. This approach aims to improve patient-centered decision-making and ensure that care aligns with the patient's values and wishes, which is different from traditional treatments that primarily focus on medical or surgical interventions.57101112
Research Team
AE
Ahmed Elsayem, MD,MPH
Principal Investigator
M.D. Anderson Cancer Center
Eligibility Criteria
This trial is for patients with advanced lung or gastrointestinal cancer who visit the emergency department of a comprehensive cancer center. Specific eligibility criteria are not provided, but typically participants would need to meet certain health conditions.Inclusion Criteria
My lung or GI cancer is advanced and cannot be cured with treatment.
Participant has the ability to speak and write in English
I experience shortness of breath, confusion, or am unable to perform daily activities.
See 2 more
Exclusion Criteria
Participant is already enrolled in hospice
Participant is new to MDACC, without established oncology care at our institution at time of ACCC arrival
Participant is comatose
See 6 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
1-2 weeks
Emergency Department Visit
Participants receive standard care or goals of care intervention during their emergency department visit
1 day
1 visit (in-person)
Follow-up
Participants are monitored for outcomes such as ICU admission, hospital death, symptom improvement, hospice referral, and survival over a 30-day period
30 days
Treatment Details
Interventions
- Goals of Care Discussion (Behavioural Intervention)
Trial OverviewThe study aims to compare two standard care approaches in the emergency setting: one focused on acute cancer care and another that includes discussions about goals of care, assessing their impact on quality of life and cost.
Participant Groups
2Treatment groups
Experimental Treatment
Group I: Goals of CareExperimental Treatment1 Intervention
In Group 2, participants will receive the above usual standard of care plus goals of care (GOC) intervention.
Group II: Acute Cancer Care CenterExperimental Treatment1 Intervention
In Group 1, participants will receive the usual standard of care, during your emergency room visit, provided by the Acute Cancer Care Center (ACCC) treating doctor who will address symptoms and other medical problems that brought the participant to the emergency room.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
MD Anderson Cancer CenterHouston, TX
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Who Is Running the Clinical Trial?
M.D. Anderson Cancer Center
Lead Sponsor
Trials
3107
Patients Recruited
1,813,000+
References
Life and treatment goals of patients with advanced, incurable cancer. [2018]Goals of care conversations have been suggested as a strategy for helping patients with advanced cancer manage the uncertainty and distress associated with end-of-life care. However, knowledge deficits about patient goals limit the utility of such conversations. We described the life and treatment goals of patients with incurable cancers, including goal values and expectancies. We examined the associations between paramount goals and patient prognosis, performance status, and psychological adjustment.
Association between strong patient-oncologist agreement regarding goals of care and aggressive care at end-of-life for patients with advanced cancer. [2023]The ability of oncologists to understand patients' goals of care is recognized as a key component of quality care. The purpose of this study is to examine the influence of patient-oncologist agreement regarding goals of care upon aggressive care at end of life (EOL) for patients with advanced cancer.
Goals of care documentation by medical oncologists and oncology patient end-of-life care outcomes. [2023]Goals of care (GOC) documentation is important but underused. We aimed to improve oncologist GOC documentation and end-of-life (EOL) care.
Using Design Thinking to Promote Goals of Care Conversations With Seriously Ill Patients. [2023]Goals of care (GOC) conversations can improve serious illness outcomes such as pain and symptom management and patient satisfaction.
Speaking Up: How Patient and Physician Voices Shaped a Trial to Improve Goals-of-Care Discussions. [2019]Patients with advanced cancer benefit from early goals-of-care (GoC) conversations, but few facilitators are known.
Impact of Adverse Events on Health Utility and Health-Related Quality of Life in Patients Receiving First-Line Chemotherapy for Metastatic Breast Cancer: Results from the SELECT BC Study. [2019]The aim of this study was to investigate the impact of adverse events (AEs) on health utility and health-related quality of life (HRQOL) in patients with metastatic breast cancer undergoing first-line chemotherapy.
Guidelines for goals of care discussions in patients with gynecologic cancer. [2023]This article represents a distillation of literature to provide guidance for goals of care discussions with patients who have gynecologic malignancies. As clinicians who provide surgical care, chemotherapy, and targeted therapeutics, gynecologic oncology clinicians are uniquely positioned to form longitudinal relationships with patients that can enable patient-centered decision making. In this review, we describe optimal timing, components, and best practices for goals of care discussions in gynecologic oncology.
Evidence-based recommendations for information and care planning in cancer care. [2022]The practice of oncology is characterized by challenging communication tasks that make it difficult to ensure optimal physician-patient information sharing and care planning. Discussions of diagnosis, prognosis, and patient goals are essential processes that inform decisions. However, data suggest that there are deficiencies in this area. We conducted a systematic review to identify the evidence supporting high-quality clinical practices for information and care planning in the context of cancer care as part of the RAND Cancer Quality-Assessing Symptoms, Side Effects, and Indicators of Supportive Treatment Project. Domains of information and care planning that are important for high-quality cancer care include integration of palliation into cancer care, advance care planning, sentinel events as markers for the need to readdress a patient's goals of care, and continuity of care planning. The standards presented here for information and care planning in cancer care should be incorporated into care pathways and should become the expectation rather than the exception.
Lessons Learned from a Multi-Site, Team-Based Serious Illness Care Program Implementation at an Academic Medical Center. [2023]Background: Patients with serious illness benefit from conversations to share prognosis and explore goals and values. To address this, we implemented Ariadne Labs' Serious Illness Care Program (SICP) at Stanford Health Care. Objective: Improve quantity, timing, and quality of serious illness conversations. Methods: Initial implementation followed Ariadne Labs' SICP framework. We later incorporated a team-based approach that included nonphysician care team members. Outcomes included number of patients with documented conversations according to clinician role and practice location. Machine learning algorithms were used in some settings to identify eligible patients. Results: Ambulatory oncology and hospital medicine were our largest implementation sites, engaging 4707 and 642 unique patients in conversations, respectively. Clinicians across eight disciplines engaged in these conversations. Identified barriers that included leadership engagement, complex workflows, and patient identification. Conclusion: Several factors contributed to successful SICP implementation across clinical sites: innovative clinical workflows, machine learning based predictive algorithms, and nonphysician care team member engagement.
Facilitators and Barriers to Oncologists' Conduct of Goals of Care Conversations. [2018]Goals of care (GoC) conversations optimally begin early in the course of cancer care, yet most happen near the end of life. We sought to describe oncologist-reported facilitators of and barriers to GoC conversations with patients who have advanced cancer.
Changing Rates of Goals of Care Designations in Patients With Advanced Pancreatic Cancer During a Multifactorial Advanced Care Planning Initiative: A Real-World Evidence Study. [2023]Goals of care (GoC) designations are an important part of advanced care planning (ACP) for patients with incurable cancers. Studies of outpatient oncology records show that most patients do not have GoC documented. We performed a retrospective analysis of changes in GoC designations in patients with advanced pancreatic cancer in Northern Alberta, Canada, during a system-wide ACP quality improvement initiative.
Oncologist Experience Implementing Goals of Care Discussions in Everyday Ambulatory Oncology Practice: Implications for Education. [2018]Despite evidence that Goals of Care (GOC) discussions should occur early in the disease trajectory, the majority occur close to end of life. In a pilot, oncologists routinely initiated GOC discussions with all patients in their everyday ambulatory practice. Following the pilot, 9 of 12 eligible oncologists participated in semi-structured interviews about their experiences. Analysis resulted in the identification of seven principles of good GOC discussions embedded in the oncologists' interviews, four barriers to engaging in GOC discussions and foundational education needs. Participants believed that the appropriate trigger for a GOC discussion is a diagnosis of advanced cancer, not simply a diagnosis of cancer, and supported the importance of selective and strategic targeting of GOC discussions. The findings have informed the development of an education-based model for culture change within a province-wide cancer care system.