Neoplasms

Digestive System Diseases

All Conditions

Respiratory Tract (Lung and Bronchial) Diseases

Gland and Hormone Related Diseases

Skin and Connective Tissue Diseases

Symptoms and General Pathology

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Gastrointestinal Neoplasms

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Neuroectodermal Tumors, Primitive

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Neoplasms by Histologic Type

Neoplasms, Nerve Tissue

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Endocrine System Diseases

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Neoplasms, Neuroepithelial

Neoplasms, Glandular and Epithelial

Stomach Diseases

Stomach Cancer

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Neuroepithelioma

Oncologists trained using OncoTalk to have Goals of Care discussions.

Training of oncologists using OncoTalk to conduct Goals of Care discussions and measure impact on patient satisfaction.

GoC intervention

Nina Bickell, MD, MPH

The goal of this study is to increase and improve Goals of Care discussions for advanced cancer patients by training medical oncologists to conduct these discussions. The investigators will evaluate the GoC discussion's effects on patient satisfaction, receipt of treatment in line with preferences, use of aggressive treatment, and oncologist communication skill.

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.

Improving Goals of Care Discussion in Advanced Cancer Patients

Improving Advanced Cancer Patient-Centered Care by Enabling Goals of Care Discussions

Number of patient's perceptions that goals of care discussions were increased occurred as measured by GoC qualitative patient survey.

Number of Patient's satisfaction with the discussion of improved goals of care as measured by GoC qualitative patient survey.

Oncologist's communication skills are tested and rated between 1 and 7, with higher number indicating the oncologists were more comfortable in demonstrating communication skills while having the Goals of Care discussion with their patients.

Patient-Centered Outcomes Research Institute

Icahn School of Medicine at Mount Sinai

Adverse events were not monitored/assessed

Patients given OncoTalk GoC intervention

GoC intervention: Training of oncologists using OncoTalk to conduct Goals of Care discussions and measure impact on patient satisfaction.

Patients - GoC Intervention

Prospective control group where no intervention was given.

Patients - Usual Care

Oncologists - GoC Intervention

Oncologists not trained using OncoTalk to have Goals of Care discussions.

Oncologists - Usual Care

Total

Age, Continuous

Sex: Female, Male

Ethnicity (NIH/OMB)

Race (NIH/OMB)

Data was collected for patient participants only

Radhi Yagnik

Oncologist - GoC Intervention

Data from patient participants only. Data not collected from Oncologists

Number of Participants Who Perceived Increased Goals of Care Discussions

Patients given OncoTalk GoC intervention.

GoC intervention: Training of oncologists using OncoTalk to conduct Goals of Care discussions and measure impact on patient satisfaction.

Data collected for patient participants only

Number of Patients Perception of Improved Goals of Care Discussions

Oncologists trained using OncoTalk to have Goals of Care discussions.

GoC intervention: Training of oncologists using OncoTalk to conduct Goals of Care discussions and measure impact on patient satisfaction.

Participants represented are the oncologist's. Data collected for the oncologists only.

Communication Skills Training

Overall Study

Nervous System Diseases

Heart and Blood Diseases

Carotid Artery Diseases

Cerebrovascular Disorders

Brain Diseases

Central Nervous System Diseases

Vascular Diseases

Carotid Ultrasound: Irradiated and non-irradiated sides of the neck in long-term survivors of pediatric cancers who received unilateral radiation therapy involving the carotid artery as part of their treatment

Bilateral carotid ultrasound measurements: A test that uses sound waves to look at the blood vessels in the neck.

Carotid Ultrasound

Winston Huh, MD

The goal of this clinical research study is to find out if long-term survivors of childhood head or neck cancer, who received radiation therapy as part of the overall treatment plan, are at increased risk of thickening or blockage of the carotid arteries (the major blood vessels in the neck).

Researchers also want to find out if other medical conditions, such as high blood sugar, high blood cholesterol, or history of tobacco use may contribute to the thickening or blockage of the carotid arteries.

Some research shows that survivors of adult head or neck cancer, who received radiation therapy, are at increased risk for thickening or blockage of the carotid arteries, which may increase the risk for other medical conditions, such as stroke. Researchers want to learn about the possible risks of thickening or blockage of the carotid arteries in survivors of childhood head or neck cancer.

If you agree to take part in this study, researchers will see if there are any possible effects (thickening or blockage) of radiation therapy on your carotid arteries. This will be done by examining the test results from routine testing (mentioned below) that is normally done for your standard long-term follow-up care of the disease. These routine tests would be performed even if you were not in this research study.

During your long-term follow-up clinic appointment, you will have a physical exam and an ultrasound test (performed at the Cardiology Clinic) of the carotid arteries. A carotid ultrasound is a test that uses sound waves to look at the blood vessels in the neck. Blood will be drawn (about 2-3 teaspoons) for laboratory tests, including blood sugar level, blood cholesterol level, blood triglyceride level, thyroid hormone level, and blood levels of certain proteins (C-reactive protein and brain natriuretic peptide).

If any of the tests show any thickening or blockage of the carotid arteries or other medical problems, such as high blood sugar, your study doctor will discuss the test results, treatment options, and/or a follow-up plan with you.

This is an investigational study. Up to 60 patients will take part in this study. All will be enrolled at M. D. Anderson.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Improving Goals of Care Discussion in Advanced Cancer Patients	NCT02374255	Primary Stage I... Esophageal Colorectal Canc... Glioblastoma Cancer of Stoma... Cancer of Pancr... Melanoma Head or Neck Ca... Stage III Stage IV Lung Cancers Pancreatic Canc...	GoC interventio...	21 Years -	Icahn School of Medicine at Mount Sinai
Carotid Artery Disease in Childhood Cancer Survivors	NCT00591539	Pediatric Cance...	Carotid Ultraso...	- 21 Years	M.D. Anderson Cancer Center
Carotid Artery Disease in Childhood Cancer Survivors	NCT00591539	Pediatric Cance...	Carotid Ultraso...	- 21 Years	M.D. Anderson Cancer Center
Carotid Artery Disease in Childhood Cancer Survivors	NCT00591539	Pediatric Cance...	Carotid Ultraso...	- 21 Years	M.D. Anderson Cancer Center
Improving Goals of Care Discussion in Advanced Cancer Patients	NCT02374255	Primary Stage I... Esophageal Colorectal Canc... Glioblastoma Cancer of Stoma... Cancer of Pancr... Melanoma Head or Neck Ca... Stage III Stage IV Lung Cancers Pancreatic Canc...	GoC interventio...	21 Years -	Icahn School of Medicine at Mount Sinai

Spots Global Cancer Trial Database for head or neck cancer