Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is making the geriatric assessment, or GA, and its summary report on patients’ age-related problems part of routine care for older patients who are considering chemotherapy at community cancer clinics.

More than two-thirds of new cancers occur in older adults. Problems related to age, such as issues with movement or memory loss, can affect how older adults respond to cancer treatment. In 2018, the American Society of Clinical Oncology issued guidelines that recommend using GAs to inform care for older adults with cancer who are considering chemotherapy. However, few community cancer clinics routinely use GAs with older patients.

What is the goal of this implementation project?

Knowing about age-related problems can help doctors, patients, and caregivers make decisions about cancer care. One way to learn about these problems is through a GA, which includes surveys and other tests. A PCORI-funded research study found that patients and caregivers who had a GA plus a summary report were more satisfied with communication about age-related concerns during cancer treatment. Patients who received the report discussed more age-related problems with their doctors than patients who had a GA alone.

This project is making the GA and summary report part of standard care at community cancer clinics to improve the quality of care for older adults with cancer.

What will this project do?

The project team is putting the GA and summary report in place at eight clinics in four states.

The project team is adapting the GA to reduce the number of tests patients take. Doing so makes it easier for clinics to make the GA part of routine care. The team is also creating a website to support use of the summary report. Clinic staff can enter patients’ GA scores into the website. Then the website produces the summary report, which includes the results of the GA and guidance for care.

To put the GA and summary report in place, the project team is:

  • Working with teams at each site to use the GA and report in practice. Teams include a clinical champion to promote the GA and report, a nurse or medical assistant, and an administrative staff member, such as a clinic manager.
  • Holding online trainings for clinical teams on how to administer the GA, discuss the results with patients and caregivers using the reports, and provide recommended referrals.
  • Working with the Association of Community Cancer Centers, or ACCC, to provide practices with support and monthly feedback on their use of the GA and summary report and ways to improve care.

The project team is also helping sites develop different ways for patients to access and complete the GA. For example, patients can use email or the patient portal. Also, patients can complete the GA at home or in the doctor’s office.

What is the expected impact of this project?

The project is demonstrating what’s required to put the GA and summary report in place at community cancer clinics. The ACCC will continue to offer support and feedback to its member clinics after the project ends.

More than 6,000 patients with cancer and their caregivers and 700 clinicians will receive the GA and report. The project evaluation will confirm that the GA and report is working as intended to improve communication and care for older adults with cancer.

More about this implementation project:

Stakeholders Involved in This Project

  • Association of Community Cancer Centers
  • Stakeholders for Care in Oncology and Research for our Elders Board (SCOREboard), an advisory board of older patients with cancer and caregivers
  • Cancer and Aging Research Group, which includes geriatric oncology clinicians and researchers
  • Community Oncology Stakeholder Group, which includes community oncologists and allied healthcare professionals (e.g., nurses, nutritionists, therapists, social workers)

Implementation Strategies

  • Adapt the GA to reduce the number of assessments and make summary reports easier for sites to use.
  • Adapt program materials and protocols to work for sites’ existing resources and workflows.
  • Provide sites with tools to support implementation, including a website to facilitate delivery of the summary report, training manuals, checklists, and electronic medical record templates.
  • Provide educational materials to patients through the GA summary report.
  • Create and support implementation teams at sites, including a clinical champion, nurse or medical assistant, and administration representative, such as a clinical manager.
  • Train clinic staff to administer, score, and interpret the GA and communicate results to patients using the summary reports.
  • Conduct cyclical small tests of change at sites.
  • Use a phased implementation approach.
  • Identify and prepare clinical champions at each site.
  • Provide technical assistance to sites, including site-specific monthly practice facilitation, quarterly group calls, audits and feedback, and ongoing consultation.
  • Partner with national stakeholder organization to develop plans for further program scale-up.

Evaluation Outcomes

To document implementation:

  • Reach to patients and caregivers (number of patients who received a GA plus a summary report based on practice logs)
  • Adoption (number of oncologists who administer the GA to older patients who are considering chemotherapy)
  • Fidelity (patient and caregiver surveys assessing whether they received a report and review of how clinic staff administer reports)
  • Clinic staff perceptions of acceptability, feasibility, appropriateness, and impact of reports

To assess healthcare and health outcomes:

  • Patient and caregiver satisfaction with communication about age-related concerns
  • Patient and caregiver quality of communication
  • Patient-reported chemotherapy toxicities
  • Patient and caregiver quality of life
  • Clinician decision making

Project Information

Lisa Lowenstein, PhD, MPH
Supriya Mohile, MD, MS
The University of Texas MD Anderson Cancer Center
$1,439,009
Implementing an Intervention to Address Concerns of Older Patients with Cancer Receiving Chemotherapy and Their Caregivers

Key Dates

July 2021
February 2025
2021

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Do Reports That Capture the Age-Related Problems of Older Patients with Cancer Improve Doctor-Patient Conversations? -- The COACH Study

Tags

Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Project Details Type
Last updated: August 24, 2022