Intervention For AYAS With Cancer Risk Syndromes

Study Overview
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Brief Summary
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This research is being done because there is a need to improve cancer risk communication and decision-making among adolescents and young adults. In this study, the investigators are looking at whether using a chatbot and online portal for cancer risk information helps improve communication and decision-making. Over 70,000 adolescents and young adults (AYAs) are diagnosed with cancer in the U.S. every year and up to 10% have genetic changes (or, mutations) that put them at a higher risk of developing new cancers during their lifetimes. These genetic mutations can result in cancer risk syndromes (such as, Lynch Syndrome or Li-Fraumeni Syndrome). Identifying cancer risk syndromes can allow for screening and early diagnosis of future cancers, which could ultimately save lives and offer more care choices for patients. As a result, genetic counseling and testing for cancer risk syndromes is being recommended more for Adolescents and Young Adults with new cancer diagnoses, regardless of family history. This research study to develop an intervention called AYA-RISE that aims to assist AYAs with cancer risk communication and decision-making around their caregivers.

Detailed Description
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This research study involves three aims (Aims 1, 2, and 3). Aim 1, Part 1, which focuses on finding the best format for the study intervention (called AYA-RISE); whether AYA-RISE is easy to use; and whether patients, family caregivers, and providers find AYA-RISE acceptable.The research study procedures include: Using and reviewing AYA-RISE, Participating in audio-recorded, 30-minute interviews Aim 1, Part 2, which is a pilot study of the study intervention (called AYA-RISE). In this pilot study, the investigators are looking at whether AYA-RISE is easy to use and what participants think of it. -- The activities involved in this part of the study are: Baseline Questionnaire Using and reviewing AYA-RISE Follow-up Questionnaire Brief feedback interviews on AYA-RISE In Aim 2, participants will be randomized trial into one of two groups; Group 1: Standard Genetic Counseling/follow-up visit or Group 2 : Standard Genetic Counseling/follow-up visit and Access to AYA-Rise Aim 3: Semi-Structured Interviews: Evaluate implementation outcomes using 28 semi-structured interviews with patients, family members, providers, and site principal investigators

Official Title
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AYA-RISE: Refining a Scalable, Patient- and Family-centered Intervention to Improve Cancer Risk Communication and Decision-making Among Adolescents and Young Adults With Cancer Risk Syndromes

Conditions
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Cancer Risk Syndrome

Intervention / Treatment
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* Behavioral: AYA-RISE Adolescents and Young Adults Risk Information and Screening Education
* Behavioral: Standard clinical visit for genetic counseling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Across all study aims, we will enroll AYA patients, family members/caregivers, and providers. AIM 1, PART 1 - STAKEHOLDER INTERVIEWS AYA Patients Ages 12-24 years, inclusive Diagnosed with a cancer risk syndrome English-speaking and -reading Receiving care at any of the study sites OR participating in the LiFraumeni Syndrome Association (LFSA) Youth Conference Adequate cognitive function per NeuroQOL indicated by a score of 30 or greater Not receiving active cancer therapy Family caregivers-Inclusion Criteria Parent/guardian, spouse/partner, or other family member who participates in the care of AYAs aged 12-24 with cancer risk syndromes English-speaking and -reading At any of the study sites Providers Inclusion Criteria (Oncologists, nurses, genetic counselors, social workers, or psychologists) English-speaking and reading Caring for AYAs aged 12-24 with cancer risk syndromes at any of the study sites AIM 1, PART 2 - INTERVENTION PILOT AYA Patients Ages 12-24 years, inclusive Diagnosed with a cancer risk syndrome English-speaking and -reading Receiving care at Dana-Farber Cancer Institute Adequate cognitive function per NeuroQOL, indicated by a score of 30 or greater Not receiving active cancer therapy Did not participate in a stakeholder interview Eligibility notes: Family caregivers of participating 12-17y patients will be eligible to participate in the pilot 12-17y patients can participate without a family member if both the patient and family member agree. Patients 18-24y will have the option to participate with or without a family member. AIM 2 - RANDOMIZED TRIAL AYA Patients Ages 12-24 years, inclusive Diagnosed with a cancer risk syndrome English-speaking and reading Has a planned post-disclosure genetic counseling or follow-up visit at any of the study sites Adequate cognitive function per NeuroQOL, indicated by a score of 30 or greater Not receiving active cancer therapy Did not participate in either part of Aim 1 (interview or pilot) Family caregivers Parent/guardian, spouse/partner, or other family member who participates in the care of AYAs aged 12-24 with cancer risk syndromes English-speaking and -reading At any of the study sites Did not participate in either part of Aim 1 (interview or pilot) AIM 3 - SEMI-STRUCTURED INTERVIEWS AYA Patients, Family Caregivers, Providers, and Site PIs Participated in the intervention arm of Aim 2, or Is a site principal investigator at one of the 4 participating study sites

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 24 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Aim 1-Part 1 Stakeholder Interview<br>This arm will focus on finding the best format for the study intervention (called AYA-RISE) whether AYA-RISE is easy to use; and whether patients, family caregivers, and providers find AYA-RISE acceptable. The research study procedures include: Using and reviewing AYA-RISE Participating in audio-recorded, 30-minute interviews | |
| Experimental: Aim 1-Part 2<br>This arm is a pilot study of the study intervention (called AYA-RISE). The activities involved in this part of the study are: Baseline Questionnaire Using and reviewing AYA-RISE Follow-up Questionnaire Brief interviews to get feedback on AYA-RISE | Behavioral: AYA-RISE Adolescents and Young Adults Risk Information and Screening Education<br>* A chatbot is a computer program that can chat with humans. The text the chatbot uses to talk with humans was created by real people, but the chatbot itself is not a real person. A company called Clear Genetics developed the original chatbot and patient portal, and this study team customized it for this research study.<br>* Other names: AYA-RISE;|
| Active Comparator: Aim 2-Genetic Counseling<br>The names of the study activities involved in this study are: Baseline Questionnaire Follow-up Questionnaire Medical record review The study procedures will all take place on the day of the patient's regularly scheduled clinic visit. Participants will be in this research study for up to 1 year. | Behavioral: Standard clinical visit for genetic counseling<br>* Standard clinical visit for genetic counseling and follow up<br>|
| Experimental: Aim 2- Genetic Counseling with AYA-RISE<br>The names of the study activities involved in this study are: Baseline Questionnaire Follow-up Questionnaire Medical record review Using the study intervention, AYA-RISE The study procedures will all take place on the day of the patient's regularly scheduled clinic visit. Participants will be in this research study for up to 1 year. | Behavioral: AYA-RISE Adolescents and Young Adults Risk Information and Screening Education<br>* A chatbot is a computer program that can chat with humans. The text the chatbot uses to talk with humans was created by real people, but the chatbot itself is not a real person. A company called Clear Genetics developed the original chatbot and patient portal, and this study team customized it for this research study.<br>* Other names: AYA-RISE;|
| No Intervention: Aim 3 Semi-structured interviews<br>Each site will conduct 30-minute interviews with patients, caregivers, and providers, and site principal investigators. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Consenting AYA use AYA-RISE | The feasibility (>70% consenting AYAs use AYA-RISE through the risk communication step of the chat and patient portal, based on use data from Clear Genetics) | 2 years | 
| Percentage of Acceptability | Acceptability (>70% AYAs consider the intervention acceptable, measured as a post-test AIM score >4.) | 2 years | 
| Change in patient knowledge of cancer risk and screening | This change will be measured by baseline and post-visit survey responses on the Knowledge of Cancer Screening and Gist Comprehension of Genetic Cancer Risk measures. | baseline to post-visit surveys up to 24 months | 
| Change in psychological distress | This change will be measured by baseline and post-visit survey responses using the psychosocial aspects of hereditary cancer (PAHC) measure. | baseline to post-visit surveys up to 24 months | 
| Patient ownership of information in the intervention arm | determined as % AYAs able to store and access portal information | 24 Months | 
| Participants who followed up for recommended care | We will identify recommended care and screening via medical record review, and whether care was received, post-visit. | screening and follow-up over the next year up to 24 Months | 
| Utilization of AYA-RISE | Chat transcripts and patient portal access | 2 Years | 
| Acceptability of AYA-RISE | Semi-structured interview: How did patients, providers, family members feel about the intervention? Was the experience positive, negative, or neutral? An analytic matrix on intervention design will be used to code of semi-structured interviews | 2 Years | 
| Adoption of AYA-RISE | An analytic matrix on intervention design will be used to code of semi-structured interviews - Semi-structured interview of Providers and Clinic Leaders Were patients and providers willing to try the intervention? Would they want to continue to use the intervention? | 2 Years | 
| Practicality of Using AYA-RISE | An analytic matrix on intervention design will be used to code of semi-structured interviews: Site PI Semi-structured interview Is it practical to continue to use AYA-RISE within constraints of clinic, provider, and patient/family needs? | 2 Years | 
| Fidelity of AYA-RISE | Site RA: Observation and Checklist Does actual implementation match the planned process? | 2 Years | 
| Sustainability of AYA-Rise | An analytic matrix on intervention design will be used to code of semi-structured interviews Can the processes required for AYA-RISE be maintained beyond the research setting? | 2 Years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cancer Risk Syndrome, LiFraumeni Syndrome Association (LFSA) Youth Conference