Leveraging behavioral science to improve patient understanding of advanced cancer - PROJECT SUMMARY
Most advanced cancer patients do not have an accurate understanding of their prognosis and treatment, which
interferes with patient-centered, high-quality healthcare. Gaining such information often requires patients to
confront stressful clinical discussions while understanding complex medical information. Existing interventions
to improve understanding largely target information delivery, without assessing and reducing psychological
barriers to hearing prognostic information accurately. This Pathway to Independence Award will equip Dr.
Heather Derry with the necessary skills to launch her independent research career, in which she aims to
identify and reduce stress-related barriers to informed medical decision-making among patients with cancer.
The candidate's prior work suggests that anxiety may reduce patients' accuracy for recently-discussed scan
results (used to monitor disease progression and inform treatment). In this career development award, the PI
will: (1) solidify targets and methods for a stress management intervention to improve patients' understanding
of prognostic information (i.e., scan results), then (2) adapt, revise, and (3) pilot test a stress management
program to reduce anxiety prior to key prognostic discussions. At Weill Cornell Medicine's distinguished Center
for Research on End-of-Life Care, the PI will receive expert mentorship and complete specialized training in
advanced cancer and end-of-life care, intervention adaptation and clinical trials, advanced psychophysiology
and statistics, and leadership. In the K99 phase, the PI will conduct an observational study to confirm pilot data
linking psychological factors to patient understanding, and investigate vagal tone (measured by heart rate
variability) as an underlying physiological mechanism for this pattern. Before an appointment to discuss scan
results during first-line treatment, 75 patients with advanced gastrointestinal or lung cancer will complete
assessments of resting heart rate and self-reported anxiety, worry, and anticipatory stress. After the
appointment, patients will report their understanding of those scan results. Patients' answers will be compared
to audio-recorded clinical visits for accuracy. Analyses will test relationships between accuracy, psychological
factors, and heart rate variability. Qualitative interviews will elicit patients' preferences for intervention
adaptations and delivery methods. In the R00 phase, the PI will use this information to adapt an existing stress
management program (a public resource) to mitigate anxiety (and/or other targets) prior to these appointments.
Finally, the intervention's feasibility, acceptability, and potential efficacy will be tested in a pilot randomized
trial, compared with usual care. Overall, the project will begin to address key psychological and physiological
factors missing from prior attempts to improve advanced cancer patients' understanding of prognostic
information. Given her prior training and research in health psychology, strong mentorship team, and proposed
training plan, Dr. Derry is well-positioned to become an independent investigator in this area, with the overall
goal of increasing quality of life and quality of care for people with advanced cancer.
