Please select the eligibility criteria that correspond to the clinical trial below.
Title: Improving Patient Outcomes in End-of-Life Care Provided by Physicians and Nurses
Brief Summary: This research study is a randomized trial to evaluate a training program that is designed to improve the communication skills of clinicians. The training program focuses on care for patients with serious illnesses and their family members, and assesses effectiveness using patient and family outcomes. The long term goal of this research is to improve communication skills of doctors and nurses, thereby improving patient and family outcomes.


Options:
A: Inclusion Criteria:

Physician:

* all internal medicine residents at either University of Washington (UW)or the Medical University of South Carolina
* who have a clinical rotation allowing implementation of the intervention.

NP Student:

* All NP Students at UW or MUSC
* in programs that train them to work with the following patient types:
* Adult patents with Cancer or other chronic, life-limiting illnesses
* Older Adults
* Adults Primary Care Patients

Patient:

One or more of the following diagnostic criteria:

* Advanced Cancer;
* Chronic obstructive pulmonary disease (COPD) with FEV1 values \< 35% predicted and/or oxygen dependent;
* Restrictive lung disease with a TLC \< 50% predicted;
* Congestive heart failure with an ejection fraction \<30% or functional deficits matching New York Heart Association Class III or IV heart failure;
* End stage liver disease including Child's Class C cirrhosis, MELD score ≥ 18, a variceal bleed, refractory ascites, or spontaneous bacterial peritonitis (SBP);
* a Charlson Comorbidity Score point value ≥6;
* in-patients with a University HealthSystem Consortium (UHC) Risk of Mortality score of major or extreme;
* OR hospitalized patients ≥ 80 years.

Family:

* The ability to speak English well enough to be able to complete the study procedures
* AND no significant dementia or delirium that would limit the family member's ability to complete instruments.

Nurse-evaluators:

* are working in the hospital or clinic with the resident or NP student enrolled in the study.

Exclusion Criteria:

* less than 18 years,
* significant dementia, delirium, or psychosis;
* the inability to speak English well enough to be able to complete the study procedures.
B: Inclusion Criteria:

1. diagnosis of cancer that falls under one of the following: A. All patients with brain cancer, inoperable hepatocellular/bile duct/gallbladder cancer, incurable non-small cell lung carcinoma (wet IIIb or IV), extensive stage small cell lung cancer, inoperable mesothelioma, inoperable pancreatic cancer or; metastatic gastric or esophageal cancer, metastatic melanoma, OR B. Patients with the following cancers, if first-line therapy has failed and limited response is expected to second-line therapy: breast cancer, colorectal cancer, head and neck cancer, leukemia, ovarian cancer, prostate cancer, renal cancer, sarcoma, lung cancer, myeloma, or lymphoma, OR C. Less than one year prognosis.
2. ability to provide informed consent,
3. cognitive ability to participate in the study
4. ability to communicate in English.

Exclusion Criteria:

1. inability to make decisions,
2. non-English speaking,
3. new patient visit
C: Inclusion Criteria: Informal Caregiver Inclusion Criteria

1. Informal caregiver of an enrolled hospice patient
2. Age 18 or over and legally able to provide informed consent
3. Involved in decisions related to pain medications
4. Access to at least one of the below:

   1. A standard land line telephone
   2. A high-speed Internet connection with operational computer
5. Without functional hearing loss or with a hearing aid that allows the participant to conduct phone or Internet conversations as assessed by the research staff (by questioning and observation

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   Exclusion Criteria:Informal caregivers of hospice patients with a life expectancy less than 14 days as assessed by the hospice nurse with the palliative performance scale (PPS) (99)

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D: Inclusion Criteria:

* Diagnosis of advanced colorectal cancer with metastasis, locally advanced pancreatic cancer, or metastatic pancreatic cancer.
* Is considering treatment with 1st line or 2nd line chemotherapy
* Treating oncologist has recommended consideration of one or more of the regimens for which we have developed informed consent materials
* Age ≥ 21
* English proficiency (reading and speaking)

Exclusion Criteria:

* Significant delirium/dementia as judged by the treating physician
* Isolated liver metastases being evaluated for curative resection

In addition, caregivers of eligible patients will also be eligible to participate in the caregivers assessments.

Answer: A