Improving Patient-Centered Communication in Breast Cancer Through Patient and Provider Interventions

NCT ID: NCT04549571

Last Updated: 2025-04-02

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

543 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-02-16

Study Completion Date

2027-01-31

Brief Summary

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This trial studies the effectiveness of two interventions on patient reported outcomes of patient centered communication and decision making about breast cancer treatment. The first intervention consists of enhancements to an existing patient-facing breast cancer treatment decision tool called iCanDecide that supports the management of worry, distress, and anxiety as compared to an existing tool. The second intervention consists of a clinician dashboard that populates information after patients view either website regarding any ongoing issues or concerns.

Detailed Description

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The primary and key secondary objectives of the study:

PRIMARY OBJECTIVES:

I. To demonstrate that the enhanced iCanDecide (iCanDecide-emotional support enhancement \[ESE\]) intervention is more effective than the standard version (iCanDecide-standard \[S\]) resulting in higher patient knowledge about locoregional treatment risks and benefits.

II. To demonstrate that the activation of the clinician dashboard (CDB) is more effective than not using a CDB, resulting in higher patient knowledge about locoregional treatment risks and benefits.

SECONDARY OBJECTIVES:

I. To demonstrate that the enhanced iCanDecide (iCanDecide-ESE) intervention is more effective than the standard version (iCanDecide-S), resulting in higher patient-reported breast cancer self-efficacy and lower patient reported cancer worry.

II. To demonstrate that the activation of the clinician dashboard (CDB) is more effective than not using a CDB, resulting in higher patient-reported breast cancer self-efficacy and lower patient reported cancer worry.

OUTLINE: This study is a multi-level trial of SHaDES that has two interventions in a factorial or crossed design: 1) an individually randomized patient-level randomized controlled trial (RCT) to evaluate the standard version (iCanDecide-S) vs. a version with innovative emotional support enhancements (iCanDecide-ESE), and 2) a clinic-level stepped-wedge cluster randomized trial to test a Clinician Dashboard (CDB). Twenty-five surgical practices will be recruited for participation. Practices will be randomized to the timing of the CDB intervention, with some practices initiating the CDB intervention right away, while others may initiate the CDB later or perhaps be randomized to "no CDB" period. Clinicians will be asked to use the CDB beginning in the time period to which their practice was randomized and continuing to the end of the study. After registration, clinicians are followed up at 9 and 18 months. After a patient is registered, the patient will be randomized to one of two arms:

ARM I: Patients utilize the iCanDecide - ESE website, then undergo surgery within 5 weeks of registration. Patients may also participate in an audio-recorded phone interview over 20 minutes at 9-12 months post registration.

ARM II: Patients utilize the iCanDecide - S website, then undergo surgery within 5 weeks of registration. Patients may also participate in an audio-recorded phone interview over 20 minutes at 9-12 months post registration.

After study registration, patients are followed up at 4-5 weeks and 9 months.

Patients will be enrolled at participating clinics during the full duration of the study and all enrolled patients will receive a version of the decision support tool (iCanDecide-S; iCanDecide-ESE). These patient-level activities are not influenced by the timing of the practice-level randomization to the CDB.

Conditions

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Anatomic Stage 0 Breast Cancer AJCC v8 Anatomic Stage I Breast Cancer AJCC v8 Anatomic Stage IA Breast Cancer AJCC v8 Anatomic Stage IB Breast Cancer AJCC v8 Anatomic Stage II Breast Cancer AJCC v8 Anatomic Stage IIA Breast Cancer AJCC v8 Anatomic Stage IIB Breast Cancer AJCC v8 Anatomic Stage III Breast Cancer AJCC v8 Anatomic Stage IIIA Breast Cancer AJCC v8 Anatomic Stage IIIB Breast Cancer AJCC v8 Anatomic Stage IIIC Breast Cancer AJCC v8 Prognostic Stage 0 Breast Cancer AJCC v8 Prognostic Stage I Breast Cancer AJCC v8 Prognostic Stage IA Breast Cancer AJCC v8 Prognostic Stage IB Breast Cancer AJCC v8 Prognostic Stage II Breast Cancer AJCC v8 Prognostic Stage IIA Breast Cancer AJCC v8 Prognostic Stage IIB Breast Cancer AJCC v8 Prognostic Stage III Breast Cancer AJCC v8 Prognostic Stage IIIA Breast Cancer AJCC v8 Prognostic Stage IIIB Breast Cancer AJCC v8 Prognostic Stage IIIC Breast Cancer AJCC v8

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Participants Caregivers
The enhanced content of the ESE version iCanDecide-ESE is available to the patient, but does not populate differently into the CDB, allowing clinicians to remain blinded to the patient-level randomization arm; therefore, both the patient and the practice and clinicians will be blinded as to which arm the patient is assigned to. However, the surgical practices and their clinicians will know when they are using the CDB so the clinician level intervention will not be blinded.

Study Groups

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Arm I: (iCanDecide - ESE)

Patients utilize the iCanDecide - ESE website, then undergo surgery within 5 weeks of registration. Patients may also participate in an audio-recorded phone interview over 20 minutes at 9-12 months post registration.

Group Type EXPERIMENTAL

Decision Aid iCanDecide - ESE website

Intervention Type OTHER

Utilize the iCanDecide - ESE website

Therapeutic Conventional Surgery

Intervention Type PROCEDURE

Undergo surgery

Interview

Intervention Type OTHER

Participate in interview

Survey Administration

Intervention Type OTHER

Ancillary studies

Quality-of-Life Assessment

Intervention Type OTHER

Ancillary studies

Arm II: (iCanDecide - S)

Patients utilize the iCanDecide - S website, then undergo surgery within 5 weeks of registration. Patients may also participate in an audio-recorded phone interview over 20 minutes at 9-12 months post registration.

Group Type ACTIVE_COMPARATOR

Decision Aid iCanDecide - S website

Intervention Type OTHER

Utilize the iCanDecide - S website

Therapeutic Conventional Surgery

Intervention Type PROCEDURE

Undergo surgery

Interview

Intervention Type OTHER

Participate in interview

Survey Administration

Intervention Type OTHER

Ancillary studies

Quality-of-Life Assessment

Intervention Type OTHER

Ancillary studies

Clinics 1-5: (CDB)

Beginning 4 weeks before the practice begins use of the CDB, clinicians receive training on how to use the CDB and utilize the CDB over weeks 1-60. Clinicians may also participate in an audio-recorded phone interview over 20 minutes.

Group Type EXPERIMENTAL

Interview

Intervention Type OTHER

Participate in interview

Training

Intervention Type OTHER

Receive training

Media Intervention

Intervention Type OTHER

Utilize the CDB

Survey Administration

Intervention Type OTHER

Ancillary studies

Clinics 6-8 (CDB)

Beginning 4 weeks before the practice begins use of the CDB, clinicians receive training on how to use the CDB and utilize the CDB over weeks 10-60. Clinicians may also participate in an audio-recorded phone interview over 20 minutes.

Group Type EXPERIMENTAL

Interview

Intervention Type OTHER

Participate in interview

Training

Intervention Type OTHER

Receive training

Media Intervention

Intervention Type OTHER

Utilize the CDB

Survey Administration

Intervention Type OTHER

Ancillary studies

Clinics 9-11 (CDB)

Beginning 4 weeks before the practice begins use of the CDB, clinicians receive training on how to use the CDB and utilize the CDB over weeks 20-60. Clinicians may also participate in an audio-recorded phone interview over 20 minutes.

Group Type EXPERIMENTAL

Interview

Intervention Type OTHER

Participate in interview

Training

Intervention Type OTHER

Receive training

Media Intervention

Intervention Type OTHER

Utilize the CDB

Survey Administration

Intervention Type OTHER

Ancillary studies

Clinics 12-14 (CDB)

Beginning 4 weeks before the practice begins use of the CDB, clinicians receive training on how to use the CDB and utilize the CDB over weeks 30-60. Clinicians may also participate in an audio-recorded phone interview over 20 minutes.

Group Type EXPERIMENTAL

Interview

Intervention Type OTHER

Participate in interview

Training

Intervention Type OTHER

Receive training

Media Intervention

Intervention Type OTHER

Utilize the CDB

Survey Administration

Intervention Type OTHER

Ancillary studies

Clinics 15-17 (CDB)

Beginning 4 weeks before the practice begins use of the CDB, clinicians receive training on how to use the CDB and utilize the CDB over weeks 40-60. Clinicians may also participate in an audio-recorded phone interview over 20 minutes.

Group Type EXPERIMENTAL

Interview

Intervention Type OTHER

Participate in interview

Training

Intervention Type OTHER

Receive training

Media Intervention

Intervention Type OTHER

Utilize the CDB

Survey Administration

Intervention Type OTHER

Ancillary studies

Clinics 18-20 (CDB)

Beginning 4 weeks before the practice begins use of the CDB, clinicians receive training on how to use the CDB and utilize the CDB over weeks 50-60. Clinicians may also participate in an audio-recorded phone interview over 20 minutes.

Group Type EXPERIMENTAL

Interview

Intervention Type OTHER

Participate in interview

Training

Intervention Type OTHER

Receive training

Media Intervention

Intervention Type OTHER

Utilize the CDB

Survey Administration

Intervention Type OTHER

Ancillary studies

Clinics 21-25 (usual care)

Beginning 4 weeks before the practice begins use of the CDB, clinicians receive training on how to use the CDB and continue to provide breast cancer surgical care per their usual care. Clinicians may also participate in an audio-recorded phone interview over 20 minutes.

Group Type ACTIVE_COMPARATOR

Interview

Intervention Type OTHER

Participate in interview

Training

Intervention Type OTHER

Receive training

Best Practice

Intervention Type OTHER

Utilize usual care

Survey Administration

Intervention Type OTHER

Ancillary studies

Interventions

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Decision Aid iCanDecide - ESE website

Utilize the iCanDecide - ESE website

Intervention Type OTHER

Decision Aid iCanDecide - S website

Utilize the iCanDecide - S website

Intervention Type OTHER

Therapeutic Conventional Surgery

Undergo surgery

Intervention Type PROCEDURE

Interview

Participate in interview

Intervention Type OTHER

Training

Receive training

Intervention Type OTHER

Media Intervention

Utilize the CDB

Intervention Type OTHER

Best Practice

Utilize usual care

Intervention Type OTHER

Survey Administration

Ancillary studies

Intervention Type OTHER

Quality-of-Life Assessment

Ancillary studies

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* PATIENT ELIGIBILITY
* Women newly diagnosed with stage 0-III breast cancer. Although men are recommended to undergo surgery to treat breast cancer, male breast cancer is relatively rare and decision making for breast cancer surgery is quite different between men and women
* Planning breast surgery as a component of their definitive treatment within 5 weeks of registration
* Receives care from a clinician and at a practice that has consented to participate in the clinician dashboard practice-level intervention. Practices/clinicians will consent initially at the initiation of the study. Patients will then be identified and recruited in those practices. If a practice has more than one clinician doing breast surgery, patients will be recruited from those clinicians who consent (one or more). Patients of clinicians who have not consented will not be eligible
* Patients must be able to speak English or Spanish with the fluency required to have a direct discussion around treatment decision-making (i.e. without interpreter)
* Age 21-84 years
* CLINICIAN STAKEHOLDER (SURGEONS AND CLINIC STAFF) ELIGIBILITY CRITERIA
* Clinicians eligible for this study include: breast surgeons and their designee(s) (e.g., physician assistants, nurse practitioners, clinical nurse specialists, or nurses) that participate in the treatment decision-making process. At least one surgical oncologist at a practice must agree to participate and sign consent. S/he may then also identify a nurse, physician assistant (PA) or advanced practice provider (APP) with whom s/he works that is involved in the delivery of the care of the same patients to participate. Henceforth, in this protocol they will be referred to as "clinicians"
* Clinicians must agree to have their patients recruited for the entire time the study is open at their practice, which will include time periods in which the clinicians will and time periods in which they will not have access to the CDB
* INSTITUTION ELIGIBILITY:
* Practices that annually provide surgical care for over 100 patients newly diagnosed with breast cancer are eligible to participate in this study
* Eligible practices must have at least one surgical oncologist who agrees to participate in the study

Exclusion Criteria

* Patients who are visually impaired are not eligible, as they must be able to access the study intervention on a website at home or in clinic and view the decision aid
* Patients with impaired decision-making capacity (such as with a diagnosis of dementia or memory loss) are not eligible for this study
* Practices currently enrolling to Alliance A231701CD are not eligible to participate in this study
Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Alliance for Clinical Trials in Oncology

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sarah T. Hawley, PhD, MPH

Role: STUDY_CHAIR

University of Michigan School of Medicine and Public Health

Locations

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Kaiser Permanente-Vallejo

Vallejo, California, United States

Site Status

Helen F Graham Cancer Center

Newark, Delaware, United States

Site Status

Beebe Health Campus

Rehoboth Beach, Delaware, United States

Site Status

Lewis Cancer and Research Pavilion at Saint Joseph's/Candler

Savannah, Georgia, United States

Site Status

Kaiser Permanente Moanalua Medical Center

Honolulu, Hawaii, United States

Site Status

SSM Health Good Samaritan

Mount Vernon, Illinois, United States

Site Status

Maine Medical Center- Scarborough Campus

Scarborough, Maine, United States

Site Status

Corewell Health Grand Rapids Hospitals - Butterworth Hospital

Grand Rapids, Michigan, United States

Site Status

West Michigan Cancer Center

Kalamazoo, Michigan, United States

Site Status

Ascension Borgess Hospital

Kalamazoo, Michigan, United States

Site Status

Northern Westchester Hospital

Mount Kisco, New York, United States

Site Status

NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

New York, New York, United States

Site Status

Montefiore Medical Center-Einstein Campus

The Bronx, New York, United States

Site Status

Novant Health Breast Surgery - Greensboro

Greensboro, North Carolina, United States

Site Status

Sanford Bismarck Medical Center

Bismarck, North Dakota, United States

Site Status

Sanford Broadway Medical Center

Fargo, North Dakota, United States

Site Status

Adena Regional Medical Center

Chillicothe, Ohio, United States

Site Status

Saint Ann's Hospital

Westerville, Ohio, United States

Site Status

Genesis Healthcare System Cancer Care Center

Zanesville, Ohio, United States

Site Status

Baptist Memorial Hospital for Women

Memphis, Tennessee, United States

Site Status

ThedaCare Regional Cancer Center

Appleton, Wisconsin, United States

Site Status

Marshfield Medical Center-EC Cancer Center

Eau Claire, Wisconsin, United States

Site Status

Aurora Cancer Care-Grafton

Grafton, Wisconsin, United States

Site Status

Gundersen Lutheran Medical Center

La Crosse, Wisconsin, United States

Site Status

Aspirus Regional Cancer Center

Wausau, Wisconsin, United States

Site Status

Ascension Medical Group Southeast Wisconsin - Mayfair Road

Wauwatosa, Wisconsin, United States

Site Status

Aurora West Allis Medical Center

West Allis, Wisconsin, United States

Site Status

Countries

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United States

References

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Hawley ST, Kidwell K, Zahrieh D, McCarthy A, Wills R, Rankin A, Hofer T, Chow S, Jagsi R, Neuman H. Improving patient-centered communication in breast cancer: a study protocol for a multilevel intervention of a shared treatment deliberation system (SharES) within the NCI community oncology research program (NCORP) (Alliance A231901CD). Trials. 2023 Jan 6;24(1):16. doi: 10.1186/s13063-022-07048-4.

Reference Type DERIVED
PMID: 36609349 (View on PubMed)

Other Identifiers

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NCI-2020-06176

Identifier Type: REGISTRY

Identifier Source: secondary_id

UG1CA189823

Identifier Type: NIH

Identifier Source: secondary_id

View Link

R01CA237046

Identifier Type: NIH

Identifier Source: secondary_id

View Link

A231901CD

Identifier Type: -

Identifier Source: org_study_id

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