Enhancing Triadic Communication About Cognition for Older Adults with Alzheimer's Disease or Related Dementias Facing a Cancer Management Decision
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Project Summary: The overarching goal of this proposal, submitted in response to RFA-AG-22-020, is to adapt an existing communication tool developed by our team for use in patients with Alzheimer’s Disease or Related Dementias (ADRD) and their care partners, and to evaluate if this tool can enhance communication about cognition in the context of a cancer management decision. This proposal is important because approximately 7% of older adults diagnosed with cancer have pre-existing dementia. For older adults with ADRD and cancer, medical decision making is more complex, and integrates information about the risks and benefits of potential interventions in the context of the dual diagnoses. Limited data are available to guide the “best” approach and thus, relies on discussions about the risks and benefits of options in the context of patient and care partner goals and preferences. Unfortunately, there is no standard approach among oncology clinicians as to how to discuss cognition in the context of a cancer management decision for patients with pre- existing ADRD and their care partners. Preliminary research by the PI (Magnuson) and team suggest that cognitive impairment is prevalent in older patients with cancer and that a geriatric assessment-based communication tool can facilitate conversations about aging-related conditions, such as cognition, with older patients and their care partners. However, the intervention was not tested in patients with ADRD and did not address patient and care partner concerns about cognition in the context of cancer. Adapting this tool for patients with ADRD (adapted tool called “COACH-Cog”) may improve both care partner and patient outcomes through greater acknowledgement and support of cognitive concerns and cognitive-related goals, thereby improving goal concordant care. COACH-Cog adaptations will include: 1) brief, focused training for oncology clinicians about ADRD in the context of cancer and communication training to navigate the triadic nature of these conversations, thereby enhancing oncology clinician knowledge and supporting their decision processes; and 2) care partner and patient Communication Coaching and Question Prompt List providing knowledge, skills, and behavioral cueing for discussing their cognitive concerns and cognitive-related goals with oncology clinicians. Focus groups with key stakeholders will guide the adaptation. Subsequently, we propose to conduct a pilot, Stage I RCT (cluster randomized at physician) with older adults with a clinical diagnosis of ADRD and their care partners (N=130 dyads) to evaluate the preliminary efficacy of COACH-Cog on care partner and patient autonomy support, care partner well-being, and goal concordance in outcomes at 3 months. Our uniquely qualified, multidisciplinary team includes expertise in geriatric oncology, cognition, behavioral neurology, intervention development, communication science, biostatistics, palliative care, and care partner research. This innovative proposal will develop a pragmatic tool for improving communication about cognition in the context of cancer treatment decision making for patients with ADRD and their care partners.
