Patient-caregiver Communication Intervention for Prognostic Understanding

A Communication-based Intervention for Advanced Cancer Patient-caregiver Dyads to Increase Engagement in Advance Care Planning and Reduce Caregiver Burden

The purpose of this study is 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).

Patient Inclusion Criteria:

• Diagnosis of poor prognosis advanced cancer defined as locally advanced or metastatic cancer (e.g., pancreaticobiliary, esophagogastric, hepatocellular carcinoma, lung, or gynecological cancer) and/or disease progression following at least first line chemotherapy.
• Ability to provide informed consent
• Identification of an informal caregiver
• Oncologist reported discussion of prognosis with the patient and/or caregiver.

Patient Exclusion Criteria:

• Not fluent in English
• Severely cognitively impaired (as measured by Short Portable Mental Status Questionnaire scores of < 6)
• Too ill or weak to complete the interviews (as judged by the interviewer)
• Currently receiving palliative care/hospice at the time of enrollment
• Children and young adults under age 18
• Deemed inappropriate for the study by their treating oncologist.
• In addition, patient-caregiver dyads in which both members have an accurate understanding of prognosis (terminal status and life-expectancy) will be excluded due to the lack of need for an intervention.

Caregiver inclusion criteria:

• The person (family member or friend) whom the patient indicates provides their informal (unpaid) care
• English speaking
• Able to provide informed consent