Hematologic Malignancies
Conditions
Keywords
Advance Care Planning Intervention, Serious Illness Conversation, Hematologic Malignancies
Brief summary
This is a pilot study to assess the preliminary efficacy of an inpatient advance care planning intervention on outcomes in older patients with hematologic malignancies
Detailed description
Older adults with hematologic malignancies receive more aggressive inpatient care at the end of life compared to patients with solid tumors. Advance care planning may promote early serious illness conversations for patients with hematologic malignancies, leading to less aggressive healthcare utilization at the end of life. This pilot aims to assess the preliminary efficacy of an inpatient advance care planning intervention on outcomes in older patients with hematologic malignancies.
Interventions
BEHAVIORALInpatient serious illness care program
Inpatient advance care planning intervention that will be delivered by advanced care practitioners or hematology/oncology fellow physicians. The intervention will be an adapted version of the serious illness care program.
Sponsors
University of Rochester
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
The intervention used in this study is an inpatient advance care planning intervention. We will adapt the Serious Illness Care Program, an evidence-based intervention that promotes serious illness conversation between patients and clinicians, to be used by advance practice providers and hematology/oncology fellow physicians in the inpatient setting.
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥60 years * A diagnosis of hematologic malignancy \[including but not limited to acute leukemia, myeloid malignancies (e.g., atypical CML, MDS/MPN overlap syndromes, CMML), multiple myeloma, lymphoma, or any other hematologic malignancies based on the primary oncologist's judgment\] * Able to provide informed consent * Being managed in the inpatient setting * English-speaking
Exclusion criteria
• None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Retention Rate | From consent until completion of the ACP intervention visit, usually within 1 week. | Retention rate is the percentage of consented patients who completed the ACP intervention visit. A retention rate of \>70% was considered feasible. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Advance Directive Completion - HCP | From baseline (pre-intervention) to 1 year post-intervention. The time interval is approximately 1 year. | Data on the patient's completion of scanned healthcare proxy form that was completed with their physician was collected via the electronic medical record. This is expressed as a percentage. |
| Advance Directive Completion - MOLST | From baseline (pre-intervention) to 1 year post-intervention. The time interval is approximately 1 year. | Data on the patient's completion of scanned medical order for life sustaining treatment (MOLST) form that was completed with their clinician was collected via the electronic medical record. This is expressed as a percentage. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORKah Poh Loh
University of Rochester
Participant flow
Recruitment details
Eligible patients being managed in the inpatient setting at the University of Rochester Medical Center (URMC) Wilmot Cancer Institute (WCI), were identified by treating physicians, APPs, hematology/oncology fellows, nurses, and study coordinators. Patients were recruited from November 2022 to October 2024.
Pre-assignment details
57 patients were approached, and 41 consented (consent rate: 71.9%). The most common reasons patients declined to participate were a reluctance to complete surveys (n=8), feeling overwhelmed by their current situation (n=5), or a belief that discussing their preferences with the care team would not be helpful (n=3).
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 68 Years STANDARD_DEVIATION 4.3 |
| Cancer diagnosis Acute lymphoblastic leukemia | 3 Participants |
| Cancer diagnosis Acute myeloid leukemia | 25 Participants |
| Cancer diagnosis Central Nervous System Lymphoma | 1 Participants |
| Cancer diagnosis Lymphoma | 3 Participants |
| Cancer diagnosis Multiple myeloma | 4 Participants |
| Cancer diagnosis Myelodysplastic syndrome | 4 Participants |
| Cancer diagnosis Plasma cell leukemia | 1 Participants |
| Cancer diagnosis duration <6 months | 24 Participants |
| Cancer diagnosis duration >= 6 months | 17 Participants |
| Cancer health literacy Adequate literacy | 39 Participants |
| Cancer health literacy Limited literacy | 2 Participants |
| Caregiver living with the patient Child/children | 1 Participants |
| Caregiver living with the patient None | 15 Participants |
| Caregiver living with the patient Partner (spouse/significant other) | 25 Participants |
| Caregiver not living with the patient Child/children | 8 Participants |
| Caregiver not living with the patient None | 26 Participants |
| Caregiver not living with the patient Other relative(s) | 2 Participants |
| Caregiver not living with the patient Partner (spouse/significant other) | 5 Participants |
| Education College/University graduate | 11 Participants |
| Education High school or below | 12 Participants |
| Education Other | 1 Participants |
| Education Post Graduate level | 5 Participants |
| Education Training after high school or some college/university | 12 Participants |
| Employment status Employed | 10 Participants |
| Employment status Homemaker | 0 Participants |
| Employment status Other | 2 Participants |
| Employment status Retired | 28 Participants |
| Employment status Unemployed | 1 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 41 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Marital status Divorced | 3 Participants |
| Marital status Married/long term, committed significant other | 24 Participants |
| Marital status Single | 5 Participants |
| Marital status Widowed | 9 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 40 Participants |
| Sex: Female, Male Female | 22 Participants |
| Sex: Female, Male Male | 19 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 2 / 41 |
| other Total, other adverse events | 0 / 41 |
| serious Total, serious adverse events | 0 / 41 |
Outcome results
None listed