Title | Giving information strategically and transparently: A pilot trial of the Oncolo-GIST intervention to promote patients' prognostic understanding. |
Publication Type | Journal Article |
Year of Publication | 2023 |
Authors | Prigerson HG, Russell D, Kakarala SE, Derry-Vick HM, Shah MA, Saxena A, Reyna VF, Ocean A, Scheff R, Maciejewski PK, Epstein AS |
Journal | Cancer Med |
Volume | 12 |
Issue | 17 |
Pagination | 18269-18280 |
Date Published | 2023 Sep |
ISSN | 2045-7634 |
Abstract | PURPOSE: Most patients with cancer lack the prognostic understanding necessary to make informed decisions. We tested the feasibility and acceptability of the Oncolo-GIST ("Giving Information Strategically and Transparently, GIST") intervention and explored its associations with patients' improved prognostic understanding. METHODS: The Oncolo-GIST intervention distills prognostic discussions into easy-to-understand talking points. Patients with metastatic cancers that progressed on ≥1 line of chemotherapy and not expected to survive 12 months (n = 31) were recruited from October 2020 through November 2022. We compared patients who discussed their progressive scans with an oncologist trained in the GIST technique or not (i.e., usual care). A primary outcome was prognostic understanding (e.g., patients reporting a life-expectancy of months) assessed within a week of the scan discussion visit. RESULTS: Oncologists (n = 4) appeared receptive to the Oncolo-GIST intervention and scored nearly perfectly on post-training tests of material mastery after a < 2-h tutorial. Post-scan discussion visit, 100% of patients who met with an Oncolo-GIST-trained clinician understood that their cancer was considered incurable (a 31% improvement from pre-visit) compared with 91% of patients meeting with usual care oncologists (an 18% improvement); 33% of patients who met with an Oncolo-GIST-trained oncologist understood that they likely had months, not years, compared to 18% in the usual care group. No statistically significant differences emerged for these changes, nor for therapeutic alliance, anxiety, or depression scores between groups. CONCLUSION: Oncolo-GIST appears to be an easily learned approach to improve prognostic understanding that neither undermines therapeutic alliances nor increases patients' anxiety or depressive symptoms. Efficacy testing in a larger trial is warranted. |
DOI | 10.1002/cam4.6420 |
Alternate Journal | Cancer Med |
PubMed ID | 37551156 |
PubMed Central ID | PMC10523975 |
Grant List | NR018693 (Prigerson/Epstein) / NR / NINR NIH HHS / United States CA197730 (Prigerson) / CA / NCI NIH HHS / United States R21 NR018693 / NR / NINR NIH HHS / United States R35 CA197730 / CA / NCI NIH HHS / United States R21 MD017704 / MD / NIMHD NIH HHS / United States |