Among patients with cancer, intervention can increase serious illness conversations for all patients and decrease end-of-life systemic therapy
MONDAY, Jan. 30, 2023 (HealthDay News) — Behavioral nudges to prompt serious illness conversations (SICs) between oncology clinicians and patients can increase SICs for all patients and can reduce end-of-life systemic therapy, according to a study published online Jan. 12 in JAMA Oncology.
Christopher R. Manz, M.D., from the Dana-Farber Cancer Institute in Boston, and colleagues examined the impact of behavioral nudges to clinicians to prompt SICs on the SIC rate and end-of-life outcomes among patients identified by a machine learning algorithm as being at high risk for death within 180 days. Data were included for 20,506 patients with cancer with 41,021 patient encounters (5,520 [13.5 percent] with high-risk patients). The trial included 16 weeks of intervention rollout after a four-week usual care control period and 24 weeks of follow-up.
The researchers found that the unadjusted SIC rates were 3.4 percent in the control period and 13.5 percent in the intervention period among high-risk patient encounters. The intervention was associated with increased SICs for all patients in adjusted analyses (adjusted odds ratio, 2.09) and decreased end-of-life systemic therapy (adjusted odds ratio, 0.25) relative to controls. No effect was seen on hospice enrollment or length of stay, inpatient death, or end-of-life intensive care unit use.
“A machine learning-based behavioral intervention led to a sustained increase in SICs and reduction in end-of-life systemic therapy among outpatients with cancer, suggesting that machine learning-based interventions can lead to long-lasting improvements in cancer care delivery,” the authors write.
Several authors disclosed financial ties to the pharmaceutical, medical technology, and health care industries.