In the complex world of oncology, where treatment decisions significantly impact the quality of life, clear communication between patients and clinicians is paramount. A recent landmark study named ACP PEACE has taken a giant stride in this domain, focusing on older patients with advanced cancer. This innovative trial combined a video decision aid for patients with specialized communication training for clinicians, aiming to enhance documented advance care planning within oncology clinics. Published in the May issue of JAMA Network Open, the study offers promising evidence that better communication tools and skills can lead to more meaningful discussions about treatment preferences and goals of care.
Advance care planning (ACP) is a critical yet often overlooked part of cancer treatment, especially for older adults with advanced disease. Many patients do not engage in detailed conversations with their healthcare providers regarding their treatment goals or personal values, which can unintentionally lead to care that either over-treats or under-treats their needs. Recognizing this gap, the ACP PEACE trial employed a stepped-wedge, cluster randomized design across 29 oncology clinics spread over three major healthcare systems, encompassing a vast patient population of 13,800 individuals. Each clinic transitioned from usual care to the intervention at different points in time, ensuring that by the end of the study, all had benefited from the new approach.
The cornerstone of the intervention was a patient-facing video decision aid, an evidence-based tool available in 25 languages, thoughtfully created to prepare patients for conversations about their care preferences. This tool empowered patients to consider their values and treatment options before talking with their clinicians. On the other side, clinicians received communication skills training designed to enhance their ability to deliver serious news sensitively, respond empathically to patients' emotions, and elicit clear articulation of patients’ goals of care. This dual approach recognized that successful advance care planning requires both informed patients and skilled, compassionate clinicians working together.
Results from the ACP PEACE trial demonstrated a significant increase in the documentation of advance care planning conversations in patients’ electronic health records when the intervention was used compared to usual care. Importantly, this improvement was driven primarily by a greater number of documented goals-of-care discussions. However, the rates of documentation related to palliative care, hospice enrollment, or limitation of life-sustaining treatments did not differ significantly between the intervention and usual care groups. This nuance highlights that while meaningful conversations about patients’ aims increased, translating these discussions into concrete care pathways remains a work in progress.
The success of ACP PEACE also underscores the importance of collaboration and commitment across healthcare systems. Researchers James Tulsky and Angelo Volandes, co-principal investigators, emphasized how equipping both patients and clinicians with the right tools and support made an impact at scale. Tulsky pointed out that shared decision-making only becomes real when everyone involved is truly aligned—patients prepared to discuss their values and clinicians trained to facilitate those discussions. Volandes reflected on the formidable logistical challenges of conducting a large-scale clinical trial amid the COVID-19 pandemic, noting that the unified dedication of frontline clinicians and healthcare leaders ensured that older adults with advanced cancer had the opportunity to thoughtfully engage in their care planning. This cultural shift toward open and documented communication is a crucial step forward in oncology care.
Importantly, the ACP PEACE initiative was supported by the National Institute on Aging through the NIH Pragmatic Trials Collaboratory, highlighting the increasing emphasis on pragmatic research designed to change real-world clinical practices. The trial’s findings hope to inspire broader adoption of video decision aids and clinician training programs, not only in oncology but across fields of medicine where advance care planning is critical. By fostering better conversations, healthcare providers can better align treatments with patient values, improve quality of life, and ultimately, honor the personal wishes of individuals facing serious illness. It’s a shining example of how blending technology, education, and compassionate care can transform healthcare delivery, particularly for some of our most vulnerable patients.
#PatientCenteredCare #AdvanceCarePlanning #CancerCare #OncologyCommunication #NIHResearch #HealthcareInnovation #SharedDecisionMaking
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