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Metastatic Colorectal CancerNCT02282722

Improving Informed Consent for Palliative Chemotherapy

A study testing Investigational informed consent for chemotherapy and Usual, standard-of-care informed consent for chemotherapy in people with Metastatic Colorectal Cancer and Metastatic Pancreatic Cancer, run by Dana-Farber Cancer Institute at 8 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Patients are routinely asked to sign an "informed consent" document prior to starting chemotherapy, indicating they understand the risks and benefits of treatment. Although this could be a strategic moment to equip patients with information they need to make truly informed medical decisions, many patients and… Read more about this study

Who is it for?
Ages 21 years and older
What is being tested?
Investigational informed consent for chemotherapy and Usual, standard-of-care informed consent for chemotherapy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
216 participants
Where
8 sitesUnited States
Study dates
10 Jun 2015to 27 Sep 2017
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Diagnosis of advanced colorectal cancer with metastasis, locally advanced pancreatic cancer, or metastatic pancreatic cancer.
  • Is considering treatment with 1st line or 2nd line chemotherapy
  • Treating oncologist has recommended consideration of one or more of the regimens for which we have developed informed consent materials
  • Age ≥ 21
  • English proficiency (reading and speaking)

Who cannot join

  • Significant delirium/dementia as judged by the treating physician
  • Isolated liver metastases being evaluated for curative resection
  • In addition, caregivers of eligible patients will also be eligible to participate in the caregivers assessments.

Trial locations and contacts

8 sites in 1 country.

8 sites in 1 country

United States8 sites
  • Beth Israel Deaconess Medical Center

    Boston, Massachusetts, 02215

  • Dana-Farber Cancer Institute

    Boston, Massachusetts, 02215

  • University of North Carolina at Chapel Hill

    Chapel Hill, North Carolina, 27599

  • Dana-Farber at Milford

    Milford, Massachusetts, 01757

  • Virginia Commonwealth University

    Richmond, Virginia, 23284

  • University of California at San Francisco

    San Francisco, California, 94143

  • Dana-Farber at South Shore

    South Weymouth, Massachusetts, 02190

  • Novant Health

    Winston-Salem, North Carolina, 27103

Other trials in United States

About this study

Official title: Improving Informed Consent for Palliative Chemotherapy: Development of a Regimen-Specific Multi-Media Informed Consent Library To Promote Patient-Centered Decision-Making About Treatment of Advanced Gastrointestinal Cancers

Patients are routinely asked to sign an "informed consent" document prior to starting chemotherapy, indicating they understand the risks and benefits of treatment. Although this could be a strategic moment to equip patients with information they need to make truly informed medical decisions, many patients and caregivers note that these conversations are less useful than they could be. The informed consent process and its associated documents suffer several limitations: 1) risks are emphasized over benefits; 2) educational materials focus on individual drugs instead of regimens; 3) information is presented in written instead of alternative written/audiovisual format; and 4) the patient perspective is lacking.

The overarching objective of this project is to develop a library of communication tools for the most common chemotherapy regimens used to treat advanced gastrointestinal cancers. Tools will include video clips and written documents that can be readily distributed, modified, and customized. This toolkit will be crafted in collaboration with oncologists and patients living with gastrointestinal cancer and improves upon existing resources in several ways: 1) balanced discussion of benefits as well as risks, 2) focus on regimens rather than drugs, 3) use of both written and video format, and 4) inclusion of the patient perspective (e.g. video clips of patients describing their experience). A panel of oncologist and patient stakeholders will evaluate the acceptability of the tools. The investigators will then conduct a randomized clinical trial to demonstrate if the informed consent toolkit improves the quality of informed consent for palliative chemotherapy. If effective, the tools will be amenable to broad dissemination via patient accessible cancer education websites and oncology clinics.

Read the detailed description

Research indicates that many patients with advanced cancer receive palliative chemotherapy without sufficient understanding of its likely risks and benefits. In surveys, many patients receive palliative chemotherapy without expressing an understanding that cure is unlikely.

The root of this problem is undoubtedly complex, but may relate to gaps in communication and patient education about the risks and benefits of treatment. Patients are routinely asked to sign an "informed consent" document prior to starting chemotherapy, indicating they understand the risks and benefits of treatment. Although this could be a strategic moment to equip patients with information they need to make truly informed medical decisions, many patients and caregivers note that these conversations are less useful than they could be. The informed consent process and its associated documents suffer several limitations: 1) risks are emphasized over benefits; 2) educational materials focus on individual drugs instead of regimens; 3) information is presented in written instead of alternative written/audiovisual format; and 4) the patient perspective is lacking.

The overarching objective of this trial is to test a suite of patient-centered videos and booklets to support informed consent for common chemotherapy regimens used to treat advanced gastrointestinal cancers. In this study, patients with metastatic colorectal cancer, locally advanced and metastatic pancreatic cancer considering treatment with first or second-line palliative chemotherapy were randomized to the usual process of chemotherapy informed consent, or usual care supplemented by access to the appropriate investigational chemotherapy informed consent video and booklet. Patients were surveyed at baseline, 2-weeks post-treatment initiation, and 3 months regarding their understanding of chemotherapy risks and benefits, decisional conflict, and other metrics of informed decision-making.

Being tested
Investigational informed consent for chemotherapy, Usual, standard-of-care informed consent for chemotherapy
Keywords
cancer, palliative, chemotherapy, metastatic, colorectal, communication, informed consent, video, education, oncology, patient-centered, outcomes research
Medical subject headings
Colorectal Neoplasms, Pancreatic Neoplasms, Neoplasms, Neoplasm Metastasis, Communication

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Investigational informed consent for chemotherapyOther

    Investigational informed consent materials consist of regimen-specific multimedia tools: a video plus a booklet.

  • Usual, standard-of-care informed consent for chemotherapyOther

    The enrolling site's institutional standard-of-care informed consent materials.

Study groups in NCT02282722
Study groupRoleWhat they receive
Usual informed consentActive comparatorStudy participant will receive usual, standard-of-care informed consent for chemotherapy materials.
Receives: Other: Usual, standard-of-care informed consent for chemotherapy
Investigational informed consentExperimentalStudy participant will receive investigational informed consent for chemotherapy materials that were developed by the study team.
Receives: Other: Investigational informed consent for chemotherapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Patients With Accurate Understanding of Chemotherapy Benefits

    Patients were asked "How likely do you think that chemotherapy is to cure your cancer?" with response options of not at all likely, a little likely, somewhat likely, very likely, and don't know. A response of "not at all likely" was considered accurate. All other responses, including don't know, were considered inaccurate.

    Measured: 3 months

Secondary outcomes (9)
  1. Number of Patients With Accurate Understanding of Chemotherapy Risks

    Patients were asked to rate the likelihood that they would experience specific side effects as a result of the chemotherapy under consideration, with separate items for nausea/vomiting, diarrhea, neuropathy, and hair loss. Patients' responses were correlated to the known side effect profile of their chemotherapy regimen and coded as accurate or inaccurate.

    Measured: 2 weeks

  2. Number of Participants With Accurate Understanding of the Goals of Palliative Chemotherapy

    Patients were asked "according to your doctor, what is the goal of the chemotherapy?" with the ability to choose any/all of the following response options: cure, control cancer growth, alleviate symptoms, prolong life, or other. Selecting either control cancer growth, and/or alleviate symptoms, and/or prolong life were defined as accurate understanding; "to cure" was considered inaccurate.

    Measured: 2 weeks

  3. Decisional Conflict When Making a Chemotherapy Treatment Choice: Modified SURE Scores

    Decisional Conflict was assessed by a modified version of the 4 item SURE instrument of Legare at al which assesses whether patients 1) are sure of the best treatment option, 2) know the risks and benefits of their treatment options, 3) are clear about which risks and benefits matter to them, and 4) whether they have sufficient support to make their treatment decision. We expanded items 2 and 3 into four separate items assessing risks and benefits individually. Responses were summed, resulting in a scale of 0-6, where 0 indicates maximum conflict and 6 indicates no conflict

    Measured: 2 weeks

  4. Number of Participants Who Achieve Their Preferred Role in Treatment Decision Making Process

    Achievement of preferred role in decision-making was assessed by the Control Preferences Scale; patients indicate the role they played in their treatment decision which is compared to their preferred role (assessed at baseline).

    Measured: 2 weeks

  5. Satisfaction When Making a Chemotherapy Treatment Choice: PACE Scores

    Satisfaction with communication during treatment decision-making process was assessed via 5 items from the Patient Assessment of Cancer Communication Experiences (PACE). Scores were averaged ("does not apply" excluded), creating a score of 1 to 4, with 4 being the most satisfied.

    Measured: 2 weeks

  6. Number of Participants Who Have End-of-life Discussions With Healthcare Proxy and Care Team

    Measured: 3 months

  7. Decisional Regret When Making a Chemotherapy Treatment Choice: Decisional Regret Scale

    Decisional Regret was assessed at the 3-month survey using Brehaut's 5-item decisional regret scale, with scores ranging from 0-100, where 100 indicates maximal regret, and 0 indicates no regret.

    Measured: 3 months

  8. Emotional Distress When Making a Chemotherapy Treatment Choice: FACT-G Assessment

    Emotional distress was assessed via the emotional wellbeing subscale of the FACT-G. Scores range from 0-24, with higher scores being more desirable.

    Measured: 3 months

  9. Patient-Reported Prognostic Understanding in Median Years

    Prognostic understanding was assessed by asking patients about their understanding of the prognosis of the typical patient with their condition (<1 year, 1-2 years, 2- 3 years, 3-5 years, 5-10 years, >10 years). This measure was adapted from the CANCORS trial.

    Measured: 3 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Nov 2014 (estimated)
  2. Study start10 Jun 2015
  3. Primary completion27 Sep 2017
  4. Study completion27 Sep 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
216 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02282722
Sponsor's protocol ID
15-143
Other IDs
CE-1304-6517, 1UG1CA189823-01
Status last verified
Sep 2021
First submitted
27 Oct 2014
Last updated
14 Oct 2021
Data monitoring committee
No
Individual data sharing
Yes: If interested in obtaining data from this project, please contact PI Deb Schrag at deb\_schrag@dfci.harvard.edu.

Publications

  • Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL, Schrag D. Patients' expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012 Oct 25;367(17):1616-25. doi: 10.1056/NEJMoa1204410.

    PubMed 23094723
  • Degner LF, Sloan JA, Venkatesh P. The Control Preferences Scale. Can J Nurs Res. 1997 Fall;29(3):21-43.

    PubMed 9505581
  • Mazor KM, Street RL Jr, Sue VM, Williams AE, Rabin BA, Arora NK. Assessing patients' experiences with communication across the cancer care continuum. Patient Educ Couns. 2016 Aug;99(8):1343-8. doi: 10.1016/j.pec.2016.03.004. Epub 2016 Mar 6.

    PubMed 26979476
  • Legare F, Kearing S, Clay K, Gagnon S, D'Amours D, Rousseau M, O'Connor A. Are you SURE?: Assessing patient decisional conflict with a 4-item screening test. Can Fam Physician. 2010 Aug;56(8):e308-14.

    PubMed 20705870
  • Brehaut JC, O'Connor AM, Wood TJ, Hack TF, Siminoff L, Gordon E, Feldman-Stewart D. Validation of a decision regret scale. Med Decis Making. 2003 Jul-Aug;23(4):281-92. doi: 10.1177/0272989X03256005.

    PubMed 12926578
  • Enzinger AC, Uno H, McCleary N, Frank E, Sanoff H, Van Loon K, Matin K, Bullock A, Cronin C, Cibotti H, Bagley J, Schrag D. Effectiveness of a Multimedia Educational Intervention to Improve Understanding of the Risks and Benefits of Palliative Chemotherapy in Patients With Advanced Cancer: A Randomized Clinical Trial. JAMA Oncol. 2020 Aug 1;6(8):1265-1270. doi: 10.1001/jamaoncol.2020.1921.

    PubMed 32672806

Questions about this trial

What is this clinical trial studying?

A study testing Investigational informed consent for chemotherapy and Usual, standard-of-care informed consent for chemotherapy in people with Metastatic Colorectal Cancer and Metastatic Pancreatic Cancer, run by Dana-Farber Cancer Institute at 8 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Oct 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 7 Feb 2018). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Patients With Accurate Understanding of Chemotherapy Benefits (time frame: 3 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02282722, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Oct 2021.

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Improving Informed Consent for Palliative Chemotherapy | AzTrials