Each person facing illness has a unique perspective on what is important/gives meaning/defines acceptable quality of life. This perspective - the individual's health-related values ? provides the foundation of patient- centered care. Articulation of values allows the individual to feel heard/respected as a person and to share in medical decision-making. Thus, in cancer care, clinician-patient discussion of values early on is essential even in the context of early stage and/or curable disease. However, existing evidence indicates a compelling need for interventions to improve this communication. Availability of palliative care specialists to help communicate about/align care with values remains limited, especially in outpatient settings. Oncology guidelines and standards call for ?primary? palliative care (i.e., by interprofessional oncology teams) as part of cancer care for every patient from time of diagnosis. We have developed an innovative intervention - Communicating with Oncology Nurses about Values from the Outset (CONVO) ? that leverages trusting relationships between patients and nurses to incorporate structured, nurse-led discussions of values in routine outpatient oncology care from the beginning, regardless of the patient's cancer stage or prognosis. The nurse summarizes the patient's values, shares this summary with patient and oncologist, includes it in the EHR for all health care providers to review, and encourages the patient to discuss these values with family/other informal caregivers or surrogates. In a pilot study at our dedicated cancer center, the CONVO intervention was feasible and acceptable to patients (mostly non-Latino Whites) and clinicians. We now propose to expand this work outside our center to include Spanish-speaking Latino cancer patients, the largest and fastest-growing minority group in the US, who have been poorly represented in prior research to improve communication around values in cancer.
Specific Aims are: 1) To translate/transcreate (linguistic plus cultural adaptation) the CONVO intervention for implementation with Spanish-speaking Latino cancer patients receiving outpatient oncologic care in their communities. 2) To evaluate the feasibility and effectiveness of this intervention as implemented in English and Spanish in different organizational contexts and communities. Latino adaptation of CONVO will use mixed methods in formative and adaptive iterative phases. To evaluate feasibility and effectiveness, we will then conduct a pre-post pilot trial of the intervention in English and Spanish at two community-based oncology clinics where Latinos are strongly represented. The primary effectiveness outcome will be the occurrence of discussion of values (Quality of Communication assessment, validated in English/Spanish) as reported by patients at 6 weeks ( 2-week window) after the timepoint for intervention delivery. This research is significant in extending/evaluating an innovative nurse-led, primary palliative care intervention that can help thousands of patients including minorities receive care aligned with their values, avoid burdensome treatments that do not serve patient goals, and reduce cancer disparities. Results will inform a future large-scale RCT.
The goal of the proposed research project is to give all cancer patients the chance to talk about their personal values (what is most important to them/what gives meaning to their lives as they face illness) with a trusted member of their clinical team ? the patient's nurse ? from the beginning of cancer treatment. With the patient's permission, the nurse will share this information with the patient's cancer doctor and others on the health team, and will help patients discuss values with their families. This project has broad relevance to public health because it will translate and adapt the values discussion process so that it is available to Spanish-speaking Latinos, who are the largest and fastest-growing minority group in the US, as well as other cancer patients.
