Pilot RCT of a patient-centered communication intervention to promote values-based treatment decision-making in older adults with AML.

Abstract

12092 Background: Older adults with acute myeloid leukemia (AML) often have limited involvement in high-stakes treatment decisions that involve tradeoffs between survival and quality of life. We developed a patient-centered communication intervention (UR-GOAL) to support values-based decision-making. We assessed how patients and oncologists discuss values during treatment decision-making and explored whether UR-GOAL improves these discussions. Methods: This pilot RCT randomized patients ≥60 years old with newly diagnosed AML to UR-GOAL vs. usual care. UR-GOAL uses best-worst scaling to help patients prior to deciding on treatment to prioritize their values, which are shared with the oncologist. Two team members blinded to arm independently coded transcribed treatment conversations for values talk, defined as discussion of what matters to patients in treatment decisions. Values included patient, disease/treatment, and sociocultural priorities; examples include quality of life, treatment effectiveness, and physician recommendation, respectively. Coders assessed the depth of values discussion (the extent to which the oncologist explored patient values beyond acknowledgment), patient engagement (e.g. patient elaborating on values and asking questions), and values alignment (whether the oncologist incorporated patients’ most important values into the treatment plan). Differences in coding were resolved by consensus. Continuous outcomes were compared using t-tests or ANOVA and categorical outcomes using chi-square or Fisher’s exact tests. Results: We included 92 patients (mean age 74 and SD 7; 63% male; 93% white). A mean of 6.0 values was discussed per encounter (SD 3.0), with fewer explored in depth (mean 1.5; SD 1.5). The number of values discussed in total and in depth did not differ between arms (total values: UR-GOAL 6.4 vs. usual care 5.7, p = 0.28; and in depth: UR-GOAL 1.4 vs. usual care 1.6, p = 0.14). However, patients showed a trend toward greater engagement in values discussions in the UR-GOAL arm compared with usual care (78% vs. 59%, p = 0.07). The values most commonly expressed by patients as most important in driving treatment decisions were treatment effectiveness (44%) and care logistics (e.g. treatment in hospital vs. clinic, 19%), followed by physician recommendation (7%), treatment toxicity (4%), and quality of life (3%). Values aligned with the treatment plan in 70% of cases (UR-GOAL 76% vs. usual care 63%, p = 0.26). Patients whose values aligned discussed more values compared with those whose values were not aligned, not discussed, or indeterminate (6.9 vs. 4.0, p < 0.01). Conclusions: Older adults with AML discuss several values with their oncologists during treatment decision-making, though fewer in depth. The UR-GOAL communication intervention may promote patient engagement in shared decision-making and value alignment. Clinical trial information: NCT05335369 .