Enhancing communication about cancer management and cancer care delivery for older adults with dementia and their care partners.

Abstract

TPS12166 Background: Dementia affects 7–10% of older adults with cancer and is associated with worse cancer outcomes. Many patients (pts) have reduced decisional capacity, leading care partners (CPs) to play a major role in cancer management decision-making, which can increase CP burden and negatively affect their well-being. Cancer communication in this population is complex, requiring clinicians to balance pt preferences, CP input, and dementia-related considerations. Despite this, no standard approach exists to support triadic communication in this setting. COACH-Cog is a triadic communication intervention that promotes shared decision-making by integrating CP involvement while centering pt values in cancer care. Methods: Eligibility: Pts are age ≥65 with a diagnosis of dementia and cancer (any type or stage), have an identified CP, and receive oncology care from a participating clinician. CPs are age ≥18 and identified by the pt. Oncology clinicians (physicians or advanced practice providers) must practice at the Wilmot Cancer Institute. Study Design: This is a pilot cluster-randomized trial (clinician-level randomization). The COACH-Cog intervention includes: 1) a brief clinician training video on dementia and its relevance to cancer care; 2) distribution of pt geriatric assessment results with care recommendations to clinicians, pts, and CPs; and (3) CP communication coaching to elicit dementia-related concerns and develop questions for the next oncology visit. Baseline measures include pt geriatric assessment and dementia severity, CP well-being (burden, quality of life, depression, anxiety), and pt/CP communication and decision-making preferences. Pts and CPs receive either COACH-Cog or usual care based on clinician randomization. The subsequent clinical encounter is audio-recorded. Outcome Measures: The primary outcome is CP autonomy support, which evaluates how supported CPs feel in the decision-making process. Secondary outcomes include healthcare communication and CP well-being. Tertiary outcomes assess goal-concordant care and decisional regret. Exploratory outcomes evaluate communication impact by integrating qualitative clinical encounter data with quantitative measures. Current enrollment includes 36 clinicians and 36 pt/CP dyads (target 40 clinicians, 130 dyads). Accrual initiated April 2025. Data collection will conclude May 2027 (NCT06313853; NIA R01 AG077053). Novel/Innovative aspects: (1) This is the first study to prospectively enroll patients with dementia in an oncology intervention trial; (2) We are evaluation of a novel triadic communication intervention targeting clinicians, pts, and CPs; and (3) We have incorporated standard procedures for assessing consent capacity and engaging Legally Authorized Representatives for pts lacking capacity given enrollment of pts with dementia. Clinical trial information: NCT06313853 .