A Pilot Study of a Sequential, Rapid Triadic Communication Intention Elicitation Intervention (PRECurSOr) to Improve Supportive Oncology Care Delivery during Outpatient Encounters Among Patients and Caregivers Experiencing Transitions in the Advanced
Approaches to communication in the outpatient oncology setting are not calibrated to address the supportive care needs of patients with advanced, incurable cancer and their caregivers. When unaddressed, patients and caregivers experience adverse outcomes, including decreased quality of care, a lack of a shared understanding of treatment goals, increased distress and anxiety, decisional conflict, and increased healthcare utilization. The success of supportive oncology care delivered alongside routine oncology care (i.e., primary palliative care) depends on expert communication to fully address supportive care needs across five domains: informational, physical, emotional, social, and spiritual. Interventions to improve this communication have produced limited impact, owing, in part, to a lack of theory-informed approaches and features that do not account for the triadic nature (patient-caregiver-provider) of these encounters. The objective of this study is to pilot a theory-informed intervention, PRECurSOr (PRior Elicitation of Communication Intentions before Sequential Oncology Encounters), which is designed to elicit supportive oncology communication intentions among the patient-caregiver-provider triad prior to an outpatient encounters to reshape communication behaviors during and outcomes following the encounter. The primary aim is to evaluate the feasibility and acceptability of PRECurSOr. The secondary aim is to describe group differences in communication behaviors and outcomes. The study utilizes qualitative inquiry to inform intervention refinement. We plan to enroll 40 patient-caregiver-provider triads (20 control, 20 PRECurSOr) in this nonrandomized pilot, where control triads will be enrolled and assessed first followed by intervention triads. PRECurSOr leverages a time-limited technique from cognitive anthropology, Freelisting, to elicit individualized communication intentions (i.e., topics individuals plan/hope to discuss) among the triad prior to an outpatient encounters. The intervention targets patients with advanced, incurable cancer who have reached a transition point in their illness (e.g., disease progression) when a broader set of supportive oncology needs are likely to be front of mind.
Kristin Levoy, PhD, is an Assistant Professor at the Indiana University (IU) School of Nursing with a joint appointment as a Research Scientist at the IU Center for Aging Research (IUCAR) at Regenstrief Institute. She is a registered nurse with certifications in oncology nursing and nursing education. Dr. Levoy’s research interest arose from over a decade of experience working with patients and caregivers affected by cancer. Her research focuses on optimizing the care planning processes through which patient and caregiver preparation for the end-of-life can be enhanced across chronic life-limiting illness trajectories, such as cancer. Her inquiry has focused on understanding ways to enhance two key care planning processes—advance care planning and serious illness communication. Her long-term research goal is to develop effective primary palliative care interventions that better support patients and caregivers while living with chronic life-limiting illnesses. Such efforts will leverage novel communication strategies and enhanced caregiver engagement in care delivery as a critical means of improving outcomes. Dr. Levoy’s research has been supported by the Robert Wood Johnson Foundation Future of Nursing Scholars Program, the American Cancer Society, a National Institute of Nursing Research institutional training grant, and the National Palliative Care Research Center’s Kornfeld Scholars Program.