Project Summary

PCORI funds implementation projects to increase awareness and promote the use of PCORI-funded research findings to improve healthcare practices and health outcomes. This project focuses on implementing findings from the following completed PCORI-funded research project: Do Reports That Capture the Age-Related Problems of Older Patients with Cancer Improve Doctor-Patient Conversations? -- The COACH Study

1. What were the results from the original PCORI-funded research study?

The COACH study found that providing a summary of the geriatric assessment (GA) results and the GA-guided recommendations to cancer doctors improved satisfaction and communication about age-related concerns. The GA looks at cognition, mental health, social support, fitness, nutrition, and independence. The GA also evaluates other health concerns and the number of prescription medications. All of these factors can impact quality of life and treatment tolerance. The original intervention will be adapted by reducing the number of assessments for each GA domain. The core component, the key areas for assessment, will be retained as will the GA summary and the GA-guided recommendations. These adaptations are necessary to make it easier for practices to implement into routine practice.

2. Why is this research finding important?

The COACH study was the first large multisite intervention to demonstrate that providing a GA summary with GA-guided recommendations to community oncologists facilitates communication about aging-related concerns and improves patient and caregiver satisfaction with communication and care. The COACH study included vulnerable older patients with cancer who had significant aging-related conditions, a population of patients highly underrepresented in clinical trials and for whom there is limited evidence on the risks and benefits of cancer treatment. These patients represent the majority of patients with cancer. Cancer treatment choices for older adults with aging-related conditions have been primarily based on data from clinical trials with younger patients and fit older adults. The GA and the corresponding care recommendations are patient-centered, resulting in improved cancer care and satisfaction with health care. The impact and meaningfulness of this study was highlighted in the American Society of Clinical Oncology (ASCO) guidelines for geriatric oncology that advocates for implementation of GA for all older adults receiving or considering chemotherapy.

3. What is the goal of this project?

The primary goal is to implement the GA in community oncology practices to improve patient-centered outcomes for older patients with cancer considering or receiving chemotherapy and their caregivers. To do this, the project team will (a) establish the effectiveness of GA on communication about age-related concerns, patient and caregiver satisfaction with communication about age-related concerns, quality of life, and patient-reported side effects of chemotherapy; (b) evaluate the success of the implementation strategies on the adoption, reach, and fidelity of implementing the GA in community oncology practices; and (c) identify the resources needed to implement GA and the GA-guided recommendations in community oncology practices for older patients considering or receiving chemotherapy.

4. What is the project team doing?

The project team is partnering with the Association of Community Cancer Centers (ACCC) for this implementation project. The ACCC is a nonprofit organization dedicated to promoting high-quality cancer care for individuals with cancer and the community. The partnership with ACCC will expand the potential reach and promote practice change on a national level outside of a research setting. The main implementation strategies are practice facilitation and education. Facilitation includes education, audit and feedback, engagement, and continuous process monitoring. The ACCC practice facilitator will work with eight medical oncology practices in Arizona, New York, South Carolina, and Wisconsin. The ACCC practice facilitator will visit the sites before implementation to understand the organization’s culture. The practices will have individual monthly calls for 12 months and group calls every three months. The ACCC facilitator will work with the practices to address barriers to implementing the GA. The University of Rochester team will train clinical staff on the GA. The clinical team will learn about the different assessments and how to administer, score, and interpret the GA. They will also learn how to communicate the results of the GA to patients and caregivers in a sensitive manner and how to use the GA to help coordinate care.

Across the participating sites, there are a total of 700 health workers, including physicians, nurse practitioners, physician assistants, and nurses. The team expects to reach about 4,000 older patients with cancer who are considering or receiving chemotherapy and their caregivers in this implementation project.

As the GA is incorporated into the clinical workflow, the cancer care team will likely notice that the GA identifies age-related health concerns that may have been missed without the GA. As a result, there will be more communication about these age-related health concerns and older patients with cancer and their caregivers will be more satisfied with the clinical encounter. In response to the identified vulnerabilities, the chemotherapy and supportive medications may be adjusted to ultimately reduce harmful side effects, such as chemotherapy-related toxicities.

5. How is the team evaluating this project?

For effectiveness, the team will use the same outcome measures that were used and selected with input from older patients and caregivers for the COACH study. The team will audio-record the clinical encounters where GA was administered. Patients and caregivers will complete the modified Health Care Climate Questionnaire to assess satisfaction with communication about age-related concerns. Patients will complete the Functional Assessment of Cancer Therapy (FACT-G) to assess quality of life and the PRO-CTCAE to assess side effects of chemotherapy. Caregivers will complete the SF-12 to assess quality of life. The surveys will be administered three months from the visit with the cancer care team. The evaluation of the impact of the implementation effort will include reach, adoption, and fidelity. For reach, practices will be asked to keep a reach log for one year. For adoption, the team will determine the number of clinicians who administer the GA for older patients considering or starting chemotherapy. For fidelity, the team will ask patients and their caregivers to complete a survey determining whether a GA was administered to them and review two administered GAs per clinic staff member.

To understand the organizational culture and the clinic staff, the team will conduct interviews with the clinic staff and observe clinic flow during site visits before implementation. The team will interview the clinic staff six months after the starting implementation. Clinic staff will be asked to complete surveys before and during implementation. These surveys will include items from the Organizational Readiness to Change Assessment to understand the organizational culture around change. The survey will include items to assess the clinic staff’s perceptions about the acceptability, feasibility, and appropriateness of the GA intervention and the impact of the GA on clinical decision making.

6. How is the team involving patients and others in making sure the findings reach people who can use them?

The team engaged patients, caregivers, and clinicians and received feedback on the scope, implementation approach, and the evaluation plan. The team will continue its work with Stakeholders for Care in Oncology and Research for our Elders Board (SCOREboard), an advisory board comprised of older patients and caregivers. The team will continue its work with the Cancer and Aging Research Group, who represent geriatric oncology researchers and front-line clinicians. The stakeholder group representing community oncologists and allied healthcare professionals (e.g., nurses, nutritionists, therapists, social workers) will be led by ACCC. The partnership with ACCC will ensure that this implementation project will extend beyond the participating practices because the implementation project will become a service offered to their members after the completion of this implementation project.

7. How will this project help ensure future uptake and use of findings from patient-centered outcomes research?

Partnering with ACCC will enhance the sustainability and scalability of this implementation project. ACCC has over 27,000 cancer care team members from 2,100 member hospitals and practices. ACCC provides education and advocacy to respond to the ever-changing landscape of cancer care. Although they are well-versed in education and technical assistance (e.g., integrating new technologies and therapies), the project team is working with them to build capacity in practice facilitation through this project. As a result, they will be able to incorporate practice facilitation to their member organizations. All products to facilitate implementation will be shared with ACCC to incorporate into their materials. These materials will include checklists, implementation manuals, EMR templates, and example clinical workflows. Also, developing a geriatric oncology resource website that will be available to the wider audience of community oncology practices will ensure future uptake and use of the team’s findings.

Project Information

Lisa Lowenstein, PhD, MPH
Supriya Mohile, MD, MS
The University of Texas MD Anderson Cancer Center
$1,439,009

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

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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
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Last updated: April 23, 2022