Developing and Testing an Interactive Visual Aid for Approaching Decision Making to Stop Cancer Treatment in Advanced Cancer

NIH NCI, 1K08CA286746

8/1/24 – 7/31/29

Garrett T. Wasp, MD MPH (Dartmouth-Hitchcock Clinic)

Mentors: Paul J. Barr (Primary mentor), Amber E. Barnato, Keley Aschbrenner, Tor Tosteson, Elizabeth Murnane

The long-term objective of this K08 Mentored Clinical Scientist Research Career Development Award is to prepare the candidate for an independent research career in health services and communication research improving care outcomes for patients with advanced cancer. Despite oncology practice guidelines emphasizing alignment in patient-clinician understanding of prognosis, treatment intent, and patient values for treatment decisions in advanced cancer, discordance is common. Consequently, one third of patients with advanced cancer receive end-of-life care inconsistent with their preferences. Existing approaches to alleviate these gaps in understanding to promote goal-concordant care have had disappointing results. Inadequate attention to emotional support and managing uncertainty likely contribute to the shortcomings of existing approaches. We hypothesize that an interactive visual aid (VIS) used by patients, their caregivers, and clinicians during an outpatient visit can efficiently and effectively prompt the necessary communication behaviors that target emotional support and uncertainty management. The candidate proposes an innovative approach to design and evaluate a VIS to facilitate patient-clinician emotional support and management of uncertainty in the context of decision-making around stopping cancer treatment (e.g., chemotherapy, radiation therapy). The training and mentoring plan is designed to provide knowledge and skills in (1) Designing and leading clinical trials, (2) Behavioral intervention development (3) Implementation science, and (4) Professional development. The proposed research will assess patient-caregiver-clinician shared understanding following a serious illness conversation in the outpatient setting (Aim 1), develop and refine a highly acceptable and usable, interactive VIS for approaching decisions to stop cancer treatment over time (Aim 2), and evaluate the usability of the developed VIS for patients with advanced cancer, their caregivers and clinicians during outpatient oncology visits (Aim 3). The candidate will use the process of user-centered design and the Behavior Change Wheel intervention development framework to guide the methods and analysis. Aim 1 is anticipated to generate novel insights into the processes promoting shared understanding, and the patient perspective on the perceived accuracy of clinician-generated documentation for serious illness conversations. Findings from Aim 1 will be used to identify the existing communication gaps for structured serious illness conversations in oncology that a VIS could address (i.e., Needs Assessment). Aims 2 and 3 will generate and evaluate a novel communication tool – VIS – for approaching decisions to stop cancer treatment. In consultation with his team of mentors and scientific collaborators/advisors, the candidate will use the training, the results of the research, and the Behavior Change Wheel intervention development framework to systematically guide the next steps in this line of work promoting goal-concordant care and submit his first R01 proposal.

This Award supports the career development of Garrett T. Wasp, MD, MPH, a medical oncologist at Dartmouth Cancer Center whose long-term career goal is to become a leading investigator in health services and communication research focused on promoting high-quality and goal-concordant cancer care. The training and mentoring plan is designed to provide knowledge and skills in designing and leading clinical trials, behavioral intervention development and testing, implementation science, and professional development. The research component follows a user-centered design process and Behavior Change Wheel intervention development framework to systematically develop and evaluate an interactive visual aid (VIS) for use by patients with advanced cancer, their caregivers, and clinicians to approach decisions to stop cancer treatment.