Aligning goals of care at the time of treatment planning with the ABC123 framework: A pilot study.

Abstract

726 Background: Older patients with incurable genitourinary (GU) cancers are at high risk for receiving care that does not align with their goals. This study assessed the feasibility and acceptability of a treatment planning framework including validated geriatric, oncologic, and palliative approaches at initial assessment to better align and improve care. Methods: This single-arm pilot study evaluated the feasibility and acceptability of the ABC123 framework for aligning cancer treatment with older adults’ goals. Originally designed for an advanced bladder cancer (ABC) population, the framework integrates 1. geriatrics (geriatric functional assessment), 2. oncology (chemotherapy toxicity), and 3. palliative care (goals-of-care discussions) delivered by an advanced practice provider. The intervention occurred within 2 weeks of the initial oncology visit and patients followed up (FU) at 1, 3, and 6 months. We enrolled patients aged ≥ 65. The primary outcome was feasibility (recruitment and retention). Secondary outcomes included patient-oncologist care alignment, acceptability, goal-concordant care (Ottawa Decision Scales and Advanced Illness Coordinating Care Survey [AICCS]), and quality of life. Results: The study was feasible with 50% of those approached consented (n = 34). Although expected attrition occurred, 16 completed the 1 mo FU and 12 completed 3 mo FU measures. The study expanded beyond bladder cancer and 9 patients had a GU cancer. At 1 mo FU, 75% patient-oncologist goals of treatment were most aligned, with 17% less aligned, and 8% least aligned (Table 1). At baseline, the mean AICCS score was 3.8, increasing to 4.4 at 3 mo (p = 0.02). No significant differences were observed for Ottawa Self-Efficacy (89.9 vs. 88.1, p = 0.49), Decision Conflict (26.7 vs. 19.6, p = 0.25), Informed subscale (29.0 vs. 23.1, p = 0.44), Value Clarity subscale (27.2 vs. 19.9, p = 0.42), or FACT-G (2.8 vs. 3.0, p = 0.89). Items were coded so a more positive outcome is indicated by a higher score except Decisional Conflict and its subscales. No differences in demographics or cancer/co-morbidities were noted between those who completed 3 mo outcomes and those who did not. Conclusions: This pilot study demonstrated the feasibility of enrollment and follow-up in older patients with incurable cancer, with staff and patients noting acceptability of the design including delivery of a primary goals of care discussion by an advanced practice provider. Excellent patient-oncologist care alignment was noted, and most patient-reported outcomes trended to improvement. A larger randomized study was planned based on this pilot experience. Goal of treatment assignment. 1-Month Oncologist Perspective PatientPerspective Supportive Life prolonging Rehabilitative Curative Supportive 0 2* 0 0 Life prolonging 0 9** 0 0 Rehabilitative 0 0 0 0 Curative 1# 0 0 0 Most aligned=**; Less aligned=*; Least aligned=#.