Patient-Centered Communication Drives Supportive Care Needs in Incurable Cancer

Patients and caregivers were given a handout explaining PRECURSOR supportive care interventions.

The Primary Palliative Care Communication Intervention (PRECURSOR) may improve the psychosocial experiences of patients with incurable gynecologic cancer and their caregivers in the outpatient setting, according to results of a pilot study presented at the 50th Annual ONS Congress.

“As cancer treatments have advanced over the last few decades, we have increasing numbers of patients living with incurable cancer as a chronic condition. We'll have nearly 700,000 patients here in the United States living with cancer as an incurable condition,” said Kristin Levoy, PhD, MSN, RN, OCN, CNE, assistant professor, Indiana University School of Nursing; research scientist, Indiana University Center for Aging Research, Regenstrief Institute; and associate member, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, during a presentation at the Congress.

“At the same time…the use of outpatient care and oncology care delivery is also increasing. This really means that patients with incurable cancer and their caregivers are really navigating a lot of complex issues from home, inclusive of disease complexity and supportive care needs. So this really puts increased onus on us as healthcare providers to address these needs when patients are interfacing with the outpatient system.”

Currently, most of the conversation around supportive care is provider-driven, and clinical tendency is to insert palliative care in the terminal setting. However, the study investigators aimed to integrate supportive care across the cancer continuum.

Oncology nurses should think of supportive care as an umbrella term, Levoy explained, with primary palliative care and specialty palliative care underneath. Primary palliative care would often be used from diagnosis, remission, recurrence, and progression, while specialty palliative care would be for comfort vs aggressive care.

PRECURSOR Intervention

Therefore, in the investigator’s PRECURSOR intervention, in real-time, the communication that occurs during the oncology visit would go in the direction of patient- and caregiver-centered discussions and away from a provider-focused agenda.

During the pre-encounter phase is the Triadic Freelisting Exercise between the patient, caregiver, and provider “with the intention that [interventions] would hopefully reshape conversation away from just the clinical and diagnostic aspects of care to also include supportive care concerns.”

The physician asks, “List all the words that come to mind when you think about the supportive care needs you hope/plan to discuss during the clinic visit today.” The providers then offer an educational handout with a visually concise description of what supportive care is, with a standardized educational script on the patient and caregiver needs.

The investigators then recorded the encounters, of which they had a script that described the five domains of supportive care concerns (physical, informational, emotional, social, and spiritual), with some example concerns underneath each.

Following the encounter, the investigators then collected survey data and conducted qualitative interviews.

Pilot Study

In the nonrandomized study, the investigators aimed to evaluate the feasibility and acceptability of PRECURSOR. Additionally, they explored group differences in communication behaviors during encounters over time, and identified intervention approaches that contributed to positive and/or negative outcomes.

The study included 10 patients in the control arm and 10 patients in the intervention arm. Patients were eligible if they had incurable gynecologic cancer, and has a consenting primary caregiver.

Overall acceptability (defined by at least 80% of participants responding that they “agree or “completely agree” with each item) was 70% among patients and 78% among caregivers. As acceptability pertained to the free listing exercise and its handouts, patients rated this at 70% for both, while caregivers reported 89% and 78%, respectively.

The number of domains that were discussed in conversation were balanced across the intervention and control arms.

“We did see some differences, with slightly more supportive care referrals occurring after those encounters in the intervention,” Levoy said. “We also coded…the content in the conversation to indicate who was bringing that topic up. And we did see a shift in more patient-driven initiated concerns and less provider-initiated conversation about concerns, but we didn't see that same pattern with the caregivers.”

Further, the investigators did not see a difference between arms in immediate perception of communication outcomes. However, lower distress and anxiety scores were reported in the intervention arm for patients. Lastly, Levoy noted that therapeutic alliance was lower across the caregivers of both arms compared to the patients.

“PRECURSOR was feasible and acceptable…[and our] secondary outcomes suggest that there is potential for more patient-centered conversation with the use of PRECURSOR,” Levoy concluded. “And it might enhance the psychosocial experiences of patients and caregivers in the outpatient setting.”

Reference:

Levoy K, Hickman S, Torke A, Matthias M, Longtin K. A primary palliative care communication intervention(PRECURSOR) for the patient-caregiver-provider triad in the setting of incurable cancer: Results of a pilot study. Presented at: 50th Annual ONS Congress; April 9-13, 2025; Denver, CO.