Pathways to Advance Targeted and Helpful Serious Illness Conversations (PATH-SIC)

Pathways to Advance Targeted and Helpful Serious Illness Conversations (PATH-SIC)

The purpose of this study is to increase serious illness conversations (SICs) about patients goals and preferences regarding their healthcare between patients with cancer and their oncology clinicians and improved care provided near the end of life.

The objective of this study is to implement an intervention in a pragmatic randomized controlled trial that uses cancer treatment pathways data to identify patients appropriate for serious illness conversations (SICs) and applies "nudges" to patients and their oncology clinicians to increase SICs and improve end of life (EOL) outcomes.

Identified participants and clinicians will be randomized into 1 or 4 groups.

• Nudge to patient and clinician
• Nudge to patient only
• Nudge to clinician only
• No nudge.

The expected enrollment is approximately 800 participants.

Inclusion Criteria:

• Patients who are aged 18 years or older, reach one of the poor prognosis nodes identified and have an upcoming appointment at one of the following Dana Farber Cancer Institute oncology clinics (including Longwood and Chestnut Hill locations)
• Breast Oncology Clinic
• Gastrointestinal Oncology Clinic
• Genitourinary Oncology Clinic
• Gynecologic Oncology Clinic
• Thoracic Oncology Clinic

Exclusion Criteria:

• Patients with an SIC documented in the Advance Care Planning module of the electronic health record in the 6 months prior to reaching a poor prognosis node
• Patients who have previously been randomized in this trial (e.g., the patient is encountering a poor-prognosis node for the second time during the trial period)