Machine-Generated Mortality Estimates and Nudges to Promote Advance Care Planning Discussion Among Cancer Patients

A Stepped-Wedge Cluster Randomized Trial Using Machine-Generated Mortality Estimates and Behavioral Nudges to Promote Advance Care Planning Discussion Among Cancer Patients

This study will use a stepped-wedge cluster randomized trial to evaluate the effect of a health system initiative using machine learning algorithms and behavioral nudges to prompt oncologists to have serious illness conversations with patients at high-risk of short-term mortality.

Patients with cancer often undergo costly therapy and acute care utilization that is discordant with their wishes, particularly at the end of life. Early serious illness conversations (SIC) improve goal-concordant care, and accurate prognostication is critical to inform the timing and content of these discussions. This study will use a stepped-wedge, cluster randomized trial to evaluate the effect of a health system initiative using machine learning algorithms and behavioral nudges to prompt oncologists to have serious illness conversations with patients at high-risk of short-term mortality. Oncology practices will be randomly assigned in sequential four-week blocks to receive the intervention.

Inclusion Criteria:

• Care for adults with cancer at the following clinics at Perelman Center for Advanced Medicine

  • Breast Oncology
  • Gastrointestinal Oncology
  • Genitourinary Oncology
  • Lymphoma
  • Melanoma and Central Nervous System Oncology
  • Myeloma
  • Thoracic / Head and Neck Oncology

• Care for adults with cancer at the Pennsylvania Hospital Oncology clinic

Exclusion Criteria:

• Providers who care for only patients with benign hematologic disorders
• Providers who see only genetic consults
• Providers who see less than 12 high-risk patients in either the pre- or post- intervention periods
• Visits for patients with lung cancer who are enrolled in an ongoing palliative care clinical trial that may lead to more SICs
• Patient visits that are for oncology genetics consults (such patients may still be included if they see their primary oncologist during the trial)
• Providers who have not undergone serious illness conversation program training (SIC)