Decision Making for Older Adults With Cancer

This is a minimal risk, pilot cluster randomized controlled trial (CRT) to determine the feasibility and acceptability of training medical oncologists to use the Best Case/Worst Case-Geriatric Oncology (BC/WC-GeriOnc) communication tool in clinical practice with older adults with cancer.

Primary Objective:

I. To assess the feasibility of study procedures and using the BC/WC-GeriOnc communication tool in medical oncology with older adults with cancer.

Secondary Objectives

I. To evaluate the acceptability and appropriateness of using the BC/WC-GeriOnc communication tool.

II. To evaluate BC/WC-GeriOnc intervention fidelity and adherence by oncologists .

Exploratory Objectives:

I. To assess shared decision making and qualitatively compare cancer decision-making discussions led by oncologists randomized to the BC/WC-GeriOnc intervention versus control.

II. To determine the variability in physician-patient communication and decision-making outcomes in the intervention and control groups III. To characterize cancer care decisions and health care utilization in the intervention and control groups.

During the lead-in phase, 2 medical oncologists and 4 participants will be enrolled. During the CRT, 7 medical oncologists, 49 patients, and up to 42 caregivers will be enrolled.

Oncologists will then be randomized 1:1 to the BC/WC-GeriOnc intervention arm or waitlist control with optional BC/WC-GeriOnc training after study completion. For each randomized oncologist, the investigators will record cancer treatment decision-making discussions with 5 patients per oncologist and ask participants and oncologists to complete study questionnaires over two-month follow-up and one semi-structured interview about the decision-making process and communication.

Each participant in the pilot CRT phase will be given the option to select one caregiver to participate as well. Caregivers will be asked to complete study questionnaires and a semi-structured interview about their decision-making experience.

Eligibility Criteria:
Inclusion Criteria for Oncologists:

1. Independently practicing medical oncology physician (non-ACGME oncology fellows who practice independently are eligible).
2. Annually care for at least 10 patients age \>=65 years with solid tumor malignancies in the outpatient setting (this criterion will be confirmed by oncologist report).
3. Willing to complete the two-hour intervention training.
4. At the time of enrollment, plans to continue outpatient practice at a University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center (HDFCCC) affiliated site for the duration of the pilot study.

Inclusion Criteria for Patients:

1. Age \>= 65 years.
2. Diagnosed with a solid tumor malignancy of any stage.
3. 3. Upcoming decision-making discussion (in-person or via video conferencing) with a participating medical oncologist.
4. Able to read, write, and understand English.
5. Able to understand and provide written, informed consent. Adequate decisional capacity to consent for this study will be determined using the UCSF Decision-Making Capacity Assessment Tool. Patients with mild cognitive impairment who have adequate decisional capacity to consent for this study will be included.

There are no performance status, organ function, or comorbidity eligibility criteria for this study.

During the CRT phase, patients will be given the option to select a caregiver to participate in the study (not required). Caregivers cannot participate without an enrolled patient. Caregivers may be a family member, partner, or friend of the participating patient.

Inclusion Criteria for Caregivers:

1. Age \>=18 years.
2. Must plan to be present during the medical oncology decision-making discussion and follow-up visits within the first 3 months.
3. Able to read, write, and understand English.
4. Able to understand and provide written, informed consent.

Exclusion Criteria:

Exclusion Criteria for Oncologists:

1. Medical oncologists who practice solely in the inpatient setting are not eligible.

Exclusion Criteria for Patients:

1. Plan for UCSF second opinion evaluation only. Patients are eligible if they plan to transfer care to UCSF at the time of enrollment.
2. Planned decision-making discussion via phone only (without video).
3. Patients participating in another cancer communication/decision support intervention study with their medical oncologist.