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Improving Advance Care Planning in Oncology: A Pragmatic, Cluster-Randomized Trial Integrating Patient Videos and Clinician Communication Training

Award Number: UH3AG060626
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: COOPERATIVE AGREEMENT
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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The novel Coronavirus Disease 2019 (COVID-19) has highlighted the importance of advance care planning (ACP) for older patients who are most at risk of dying, and a critical need exists to optimize this process. ACP empowers patients to express their values and goals for care before they become too ill to do so. ACP also prepares patients, and their families, to make difficult decisions in real time when the moment arises. For older patients, COVID-19 may result in respiratory failure and high mortality rates. However, many older patients may prefer to avoid these interventions, especially if the mortality rate is high and death is experienced alone in the hospital without family nearby. Motivated by the disproportionate risk to older patients from COVID-19 and the higher mortality rates, primary care clinicians should engage all older patients with ACP to ensure their preferences are known and honored. Unfortunately, many clinicians have not been trained in ACP and patients are unfamiliar with it. To address this gap, we have developed a Comprehensive Telehealth ACP Program for COVID-19 that implements ACP routinely into medical care and responds to the present need for virtual communication. The ACP Program combines two well-tested, evidence-based, and complementary interventions: online clinician communication skills training and ACP patient video decision aids. The overall objective of this application is to reduce the burden of COVID-19 and its consequences for an aging US population that may prefer to forgo aggressive potentially ineffective interventions, and to die outside of the hospital setting. To accomplish this, we propose to conduct a Pre-Post trial using an open cohort design of a telehealth ACP Program among older patients in the nation's COVID-19 epicenter, New York. We will train 250 primary care clinicians caring for 25,000 diverse patients over the age of 65 from the largest health care system in New York (Northwell Health). We will use Natural Language Processing to abstract our outcomes from the electronic health records for patients. We hypothesize that a telehealth ACP Program of clinician serious illness communication skills training combined with ACP videos will improve and sustain rates of ACP from the time that the intervention is implemented compared to the time prior to the intervention. Clinician communication training and video decision support is a practical, evidence-based, and innovative approach to uniformly provide robust ACP. Major strengths of this proposal are: the highly experienced team making this project feasible; the present infrastructure already embedded at Northwell Health, which has the largest number of COVID-19 patients in the US; and, the potential immediate deployment of the intervention, if successful, across the country. This work holds the promise of improving the quality of care provided to millions of Americans during the COVID-19 pandemic.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2022	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	5	10/24/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $633,619 )
2022	2022	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	005	5	8/18/2022	NON-COMPETING CONTINUATION	$1,643,692
2022	2021	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	004	4	8/16/2022	NON-COMPETING CONTINUATION	$0
2022	2021	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	003	4	7/18/2022	NON-COMPETING CONTINUATION	$0
2022	2021	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	002	4	4/29/2022	NON-COMPETING CONTINUATION	$0
2022	2020	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	3	10/27/2021	SUPPLEMENT FOR EXPANSION	$0
2022	2020	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	001	3	11/3/2021	SUPPLEMENT FOR EXPANSION	-$1,010,073
														Subtotal = $633,619

Issue Date FY: 2021 ( Subtotal = $1,655,177 )
2021	2021	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	001	4	7/30/2021	NON-COMPETING CONTINUATION	$1,655,177
2021	2020	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	3	3/5/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $1,655,177

Issue Date FY: 2020 ( Subtotal = $4,094,925 )
2020	2020	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	002	3	6/19/2020	NON-COMPETING CONTINUATION	$1,672,370
2020	2020	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	003	3	9/9/2020	SUPPLEMENT FOR EXPANSION	$2,405,961
2020	2019	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	001	2	2/11/2020	EXTENSION WITH OR WITHOUT FUNDS	$0
2020	2019	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	2	1/29/2020	EXTENSION WITH OR WITHOUT FUNDS	$16,594
														Subtotal = $4,094,925

Issue Date FY: 2019 ( Subtotal = $1,691,139 )
2019	2019	DANA-FARBER CANCER INSTITUTE, INC.	450 BROOKLINE AVE	BOSTON	MA	02115	SUFFOLK	USA	Aging Research	000	2	7/5/2019	EXTENSION WITH OR WITHOUT FUNDS	$1,691,139
														Subtotal = $1,691,139

Grand Total All Awards = $8,074,860

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Improving Advance Care Planning in Oncology: A Pragmatic, Cluster-Randomized Trial Integrating Patient Videos and Clinician Communication Training

Award Number: UH3AG060626

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: COOPERATIVE AGREEMENT

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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