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

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

78 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-07-15

Study Completion Date

2020-04-19

Brief Summary

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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.

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Detailed Description

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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.

Conditions

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Oncology

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Practices will be cluster-randomized in 4-week blocks to the intervention over a 16-week period, after which all practices will receive the email intervention.

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

The principal study investigator and data analyst will not have knowledge of when the practices are randomized to the intervention.

Study Groups

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Control

Clinicians will receive current standard communications regarding serious illness performance.

Group Type NO_INTERVENTION

No interventions assigned to this group

Mortality Estimates and Nudges

Clinicians will receive a weekly email with upcoming patients that have high mortality estimates to consider for a serious illness conversation. Clinicians will have the opportunity to review the list and pre-commit (using an opt-out design) to patients appropriate for a conversation. They will receive a nudge on the day of the patient visit through a text message reminding them of their pre-commitment to conduct a serious illness conversation

Group Type EXPERIMENTAL

Nudge

Intervention Type BEHAVIORAL

Oncology practices will be randomly assigned to receive an intervention, in which individual clinicians will receive a weekly audit email detailing how many serious illness conversations (SIC) they have had compared to the recommended level, and a link to a list of their patients scheduled in clinic next week at high risk of short-term mortality as identified by a mortality prediction algorithm. Clinicians will have the chance to review the opt-out list and pre-commit to a serious illness conversation with appropriate patients. Clinicians will receive nudge on the day of the patient visit via text message reminding them of their pre-commitment to conduct a serious illness conversation.

Interventions

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Nudge

Oncology practices will be randomly assigned to receive an intervention, in which individual clinicians will receive a weekly audit email detailing how many serious illness conversations (SIC) they have had compared to the recommended level, and a link to a list of their patients scheduled in clinic next week at high risk of short-term mortality as identified by a mortality prediction algorithm. Clinicians will have the chance to review the opt-out list and pre-commit to a serious illness conversation with appropriate patients. Clinicians will receive nudge on the day of the patient visit via text message reminding them of their pre-commitment to conduct a serious illness conversation.

Intervention Type BEHAVIORAL

Eligibility Criteria

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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)

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No