Integrating machine-generated mortality estimates and behavioral nudges to promote serious illness conversations for cancer patients: Design and methods for a stepped-wedge cluster randomized controlled trial.
Advance care planning
Behavioral nudges
End of life care
Machine learning
Mortality predictions
Serious illness conversations
Journal
Contemporary clinical trials
ISSN: 1559-2030
Titre abrégé: Contemp Clin Trials
Pays: United States
ID NLM: 101242342
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
21
11
2019
revised:
10
01
2020
accepted:
21
01
2020
pubmed:
27
1
2020
medline:
20
5
2021
entrez:
27
1
2020
Statut:
ppublish
Résumé
Patients with cancer often receive care that is not aligned with their personal values and goals. Serious illness conversations (SICs) between clinicians and patients can help increase a patient's understanding of their prognosis, goals and values. In this study, we describe the design of a stepped-wedge cluster randomized trial to evaluate the impact of an intervention that employs machine learning-based prognostic algorithms and behavioral nudges to prompt oncologists to have SICs with patients at high risk of short-term mortality. Data are collected on documented SICs, documented advance care planning discussions, and end-of-life care utilization (emergency room and inpatient admissions, chemotherapy and hospice utilization) for patients of all enrolled clinicians. This trial represents a novel application of machine-generated mortality predictions combined with behavioral nudges in the routine care of outpatients with cancer. Findings from the trial may inform strategies to encourage early serious illness conversations and the application of mortality risk predictions in clinical settings. Clinicaltrials.gov Identifier: NCT03984773.
Identifiants
pubmed: 31982648
pii: S1551-7144(20)30029-X
doi: 10.1016/j.cct.2020.105951
pmc: PMC7910008
mid: NIHMS1555713
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT03984773']
Types de publication
Clinical Trial Protocol
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
105951Subventions
Organisme : NIGMS NIH HHS
ID : T32 GM075766
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors have no conflict of interest disclosures relevant to this project. Outside of the scope of this work, Dr. Parikh serves as a consultant for GNS Healthcare. Dr. Patel is supported by career development awards from the Department of Veterans Affairs HSR&D, and is a founder of Catalyst Health, a technology and behavior change consulting firm.
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