Results Summary
What was the research about?
Problems related to age can affect how older adults respond to treatment for advanced cancers. These problems may include:
- Memory loss
- Issues with movement or balance
- Poor nutrition
- Lack of support from friends and family
- Mental health problems
- Chronic health problems, like heart disease or diabetes
Doctors’ knowledge of these problems may improve patients’ care and quality of life. However, doctors don’t always know about these concerns when they talk with patients and their caregivers during office visits for cancer.
In this study, the research team wanted to see if a report about problems related to a patient’s age would help to improve communication among the patient, caregiver, and doctor. All patients in the study took surveys and tests about age-related problems. The team compared patients and caregivers who had a report with those who didn’t have one.
What were the results?
Compared with patients without a report, patients who had one:
- Were more satisfied that the talk with their doctor covered age-related problems
- Talked about more age-related problems with the doctor
Further, patients’ caregivers were more satisfied that the talk with the doctor covered the patient’s age-related problems.
The groups didn’t differ in the patients’ or caregivers’ rating of their quality of life.
Who was in the study?
The study included 541 patients with advanced cancer and 414 caregivers. Patients were getting treatment at one of 31 cancer clinics. Of the patients, 89 percent were White, 7 percent were Black, and 4 percent were other races. The average age was 77, and 51 percent were men.
What did the research team do?
The research team assigned cancer clinics by chance to one of two groups. In one group, patients, caregivers, and doctors got and reviewed a report about the patient’s age-related problems before the patient’s first office visit. The report also recommended tests and treatments.
In the second group, the research team didn’t provide the report. Doctors got alerts only if the survey or test results found that the patient had problems with depression or learning and memory.
One to two weeks after the visit, patients and caregivers got a telephone call asking how satisfied they were with their talk with the doctor about age-related problems. The research team also reviewed audio recordings of office visits to count how many age-related problems doctors and patients talked about. Patients and caregivers filled out surveys about quality of life at follow-up visits over the next six months.
Patients with cancer, caregivers, and cancer doctors helped plan and conduct the study.
What were the limits of the study?
The research team looked at one patient visit only. The results may have differed if the team included multiple visits.
Future research could look at conversations about age-related problems across multiple visits.
How can people use the results?
Patients, caregivers, and doctors can consider the results when planning advanced cancer care in older patients.
Professional Abstract
Objective
To compare the effectiveness of a patient-reported geriatric assessment (GA) plus a summary report to patients, caregivers, and oncologists versus GA completion alone in improving patient satisfaction with communication about age-related concerns during advanced cancer treatment<
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | Patients ages 70 or older with advanced solid tumor cancer or lymphoma |
| Interventions/ Comparators |
|
| Outcomes |
Primary: patient satisfaction with communication about age-related concerns during cancer treatment Secondary: number of age-related concerns raised during office visit; patient quality of life, caregiver satisfaction with communication about age-related concerns for cancer treatment |
| Timeframe | 7- to 14-day follow-up for primary outcome |
This cluster-randomized controlled trial examined the effectiveness of completing a GA plus providing a summary report with recommendations for tests and treatments to patients, caregivers, and oncologists versus GA completion with no summary report (GA alone) in improving patient-doctor communication outcomes. The GA consisted of patient-reported surveys and tests about age-related domains that can influence the effectiveness of cancer treatment. These domains included chronic illness, physical function, nutrition, social support, mental health, and cognitive skills. The GA summary report highlighted key GA results and also included recommended tests and treatments.
Researchers randomly assigned 31 oncology practices to one of two groups. In one group, before a patient’s first visit to the practice, patients, caregivers, and their oncologists completed a GA and then received the summary report. In the second group, patients completed the GA but did not receive the summary report; researchers notified oncologists only if a patient’s GA indicated problems with cognition or depression.
The study included 541 patients diagnosed with advanced cancer and 414 caregivers. Among patients, 89% were White, 7% were Black, and 4% were other races. The average age was 77, and 51% were male.
Seven to 14 days after the visit, patients and caregivers received a telephone call asking how satisfied they were with the communication about age-related concerns during the visit with the oncologist. Researchers also reviewed audio recordings of the visit to count how many times patients, caregivers, and oncologists talked about age-related concerns. Patients and caregivers completed surveys about their quality of life at follow-up visits over the next six months.
Patients with cancer, caregivers, and oncologists helped plan and conduct the study.
Results
Compared with patients who completed the GA but received no summary report, patients who completed the GA and received the summary report had:
- Higher satisfaction with communication with their oncologist about age-related concerns (p=0.04)
- More age-related concerns raised during the office visit (p<0.001)
Compared with caregivers who completed the GA but received no summary report, caregivers who completed the GA and received the summary report had higher satisfaction with communication with the oncologist about patients’ age-related concerns (p=0.03).
The groups did not differ in patients’ or caregivers’ quality of life.
Limitations
Researchers looked at conversations during one clinic visit only. Results may have been different if researchers included conversations during later visits.
Conclusions and Relevance
The summary report provided in addition to the GA improved patients’ and caregivers’ satisfaction with communication about age-related concerns.
Future Research Needs
Future research could examine conversations about age-related concerns across multiple visits.
Final Research Report
View this project's final research report.
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Journal Citations
Article Highlight: Age-related challenges—including memory loss, limited caregiver availability, or chronic conditions—can affect how older adults respond to treatment for cancer, but physicians sometimes aren’t aware of them. This study wanted to see if a report about issues related to a patient’s age would improve care-planning communication among the patient, caregiver, and doctor. As reported in JAMA Oncology, compared with patients without a report, patients who had one were engaged in and more satisfied with conversations with their physician.
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers observed a few discrepancies between the abstract and other parts of the report regarding the primary and secondary aims as well as the outcome measures. They asked for the use of more consistent language in describing outcomes. The researchers revised the report as requested, especially the abstract, and specifically in describing caregiver use of the Health Care Climate Questionnaire (HCCQ). The researchers also added mention of nonsignificant findings about patient and caregiver health-related quality of life to the abstract to make sure that the abstract included all outcomes.
- The reviewers noted that the researchers used outcome data from the 4- to 6- week visit HCCQ when the 10- to 14-day post-visit data were not available. They asked the researchers how often this occurred and what the potential impact could be on the results. The researchers explained that they used the 4- to 6-week visit data in place of missing 10- to 14-day data in 60 patients. The researchers then looked at the outcomes trends for patients who completed both data points and found that the HCCQ values for age-related conversations decreased from the 10- to 14-day measurement to the 4- to 6-week measurement, indicating that the imputed values for those 60 patients should have been slightly lower than would have been expected if 10- to 14-day data were available. This led the researchers to conclude that their imputed results for 10- to 14-day outcomes should be considered conservative.
- The reviewers noted that once researchers added six-month outcome data to the longitudinal models, it was evident that the group differences in caregiver satisfaction with communication visible at four to six weeks was no longer visible at six months. The reviewers asked the researchers to change their conclusions accordingly. The researchers countered that because the intervention did show improvement in caregiver satisfaction at 4-6 weeks, it was reasonable to conclude that the intervention performed better than the control group on this measure. They did revise their conclusions to acknowledge that the benefits evident at four to six weeks did not persist to six months.