Colorectal Cancer Clinical Trial
Official title:
Improving Advanced Cancer Patient-Centered Care by Enabling Goals of Care Discussions
The goal of this study is to increase and improve Goals of Care discussions for advanced cancer patients by training medical oncologists to conduct these discussions. The investigators will evaluate the GoC discussion's effects on patient satisfaction, receipt of treatment in line with preferences, use of aggressive treatment, and oncologist communication skill.
Among advanced cancer patients, discussions about prognosis, goals of care (GoC) and
end-of-life preferences improve quality of life of patients and reduce rates of hospital and
ICU admission. Yet, few patients know their chemotherapy treatments will not cure their
disease despite nearly all wishing to receive information- good & bad. Currently, 37% of
advanced cancer patients have GoC clarifying discussions and when they do, it is often in the
last 2 months of life when symptoms are uncontrollable and oncologists have no other
treatments to offer. These discussions do not usually happen with the patient's personal
oncologist. Current efforts to teach oncologists such skills are impractical, requiring a lot
of time away from their office practice and do not take into account job pressures.
The goal of this study is to increase and improve GoC discussions for advanced cancer
patients by training medical oncologists to conduct these discussions and evaluate its
effects on patient satisfaction, receipt of care in line with preferences, aggressive care
utilization, and oncologist communication skill.
The investigators will recruit 280 patients of which half will come from intervention doctors
and the other from the control doctors. The investigators will train randomly selected
oncologists to conduct GoC discussion. Patients will be surveyed at baseline within days of
their GOC visit and at 6 months. Oncologists will be audio-taped at baseline and after
training is complete to assess practice and skill to conduct GoC discussions.
Primary outcomes include patient reported conduct of and satisfaction with GoC discussion.
Secondary outcomes include oncologist communication skills, feasibility of performing GoC in
the outpatient setting, receipt of care in line with preferences, use of hospice,
chemotherapy or ICU in the last 30 days of life.
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