Improving Goals of Care Discussion in Advanced Cancer Patients

Among advanced cancer patients, discussions about prognosis, goals of care (GoC) and
end-of-life preferences improve quality of life of patients and reduce rates of hospital and
ICU admission. Yet, few patients know their chemotherapy treatments will not cure their
disease despite nearly all wishing to receive information- good & bad. Currently, 37% of
advanced cancer patients have GoC clarifying discussions and when they do, it is often in the
last 2 months of life when symptoms are uncontrollable and oncologists have no other
treatments to offer. These discussions do not usually happen with the patient's personal
oncologist. Current efforts to teach oncologists such skills are impractical, requiring a lot
of time away from their office practice and do not take into account job pressures.

The goal of this study is to increase and improve GoC discussions for advanced cancer
patients by training medical oncologists to conduct these discussions and evaluate its
effects on patient satisfaction, receipt of care in line with preferences, aggressive care
utilization, and oncologist communication skill.

The investigators will recruit 280 patients of which half will come from intervention doctors
and the other from the control doctors. The investigators will train randomly selected
oncologists to conduct GoC discussion. Patients will be surveyed at baseline within days of
their GOC visit and at 6 months. Oncologists will be audio-taped at baseline and after
training is complete to assess practice and skill to conduct GoC discussions.

Primary outcomes include patient reported conduct of and satisfaction with GoC discussion.
Secondary outcomes include oncologist communication skills, feasibility of performing GoC in
the outpatient setting, receipt of care in line with preferences, use of hospice,
chemotherapy or ICU in the last 30 days of life.

Inclusion Criteria:

- Men or women who are at least 21 years of age who have been diagnosed within one month
with a pathologically confirmed advanced cancer who have an average of <2 y life
expectancy (primary stage IV hepatobiliary, esophageal, colorectal, glioblastoma,
gastric, pancreatic, melanoma, head & neck, or stage III or IV lung or pancreatic
cancers) and are being treated at one of the participating hospital sites and speak
English or Spanish.

- Oncologists who treat at least 2 advanced cancer patients per month at a study
participating hospital will be enrolled into the study.

Exclusion Criteria:

- Patients who have seen an oncologist after undergoing first line treatment imaging as
this group has a higher likelihood of having received a goals of care discussion.

- Men or women who do not speak English or Spanish will be excluded.