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. 2023 Sep;12(17):18269-18280.
doi: 10.1002/cam4.6420. Epub 2023 Aug 8.

Giving information strategically and transparently: A pilot trial of the Oncolo-GIST intervention to promote patients' prognostic understanding

Holly G Prigerson  1   2 , David Russell  3 , Sophia E Kakarala  1   2 , Heather M Derry-Vick  4 , Manish A Shah  5 , Ashish Saxena  5 , Valerie F Reyna  6 , Allyson Ocean  5 , Ronald Scheff  5 , Paul K Maciejewski  1   2   7 , Andrew S Epstein  8
Affiliations

Giving information strategically and transparently: A pilot trial of the Oncolo-GIST intervention to promote patients' prognostic understanding

Holly G Prigerson et al. Cancer Med. 2023 Sep.

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.

Keywords: cancer; communication intervention; prognostic understanding; terminal illness acknowledgment.

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Conflict of interest statement

Dr. Epstein discloses royalties from Up‐To‐Date for peer reviewing GI medical oncology and palliative care topic reviews; Dr. Ocean discloses royalties from Guardant Health and Natera, Dr. Shah discloses research funding from Merck Inc., Bristol Meyers Squibb, and Oncoloys Biopharma; Dr. Derry‐Vick discloses an unrelated financial relationship with Dechra through her spouse's employment, Dr. Saxena discloses relationships to AstraZeneca Advisory Boards and G1 Therapeutics. All the remaining authors report nothing to disclose.

Figures

FIGURE 1
FIGURE 1
CONSORT diagram of study recruitment and enrollment.
FIGURE 2
FIGURE 2
Histograms showing distributions of prognostic understanding scores at pre‐ and post‐scan visits.
FIGURE 3
FIGURE 3
Weighted scatter plots showing changes in prognostic understanding scores between pre‐ and post‐scan visits.
See this image and copyright information in PMC

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