Clinical trial · Interventional
Algorithm-enabled Goals of Care Communication
Algorithm-Enabled Engagement of Patients With Advanced Cancer (A-EPAC) to Improve Goals of Care Communication Among Veterans With Advanced Stages of Cancer
- Source
- ClinicalTrials.gov
- Retrieved
- Sep 8, 2026
- Layer
- normalized (units and labels harmonized; values unchanged)
- Run
- ING-CLINICALTRIALS-20260908-000001
Summary
Brief summary (as posted)
In 2017, the VA launched the Life-Sustaining Treatment Decisions Initiative (LSTDI), a national program to promote Goals of Care communication between clinicians and patients regarding goals and preferences for care. Despite clinician training and standardized Life Sustaining Treatment (LST) notes in the electronic health record (EHR), 60% of Veterans with cancer have not engaged in such communication with their oncology clinicians before death. Over the past 10 years, the team developed and tested: 1) a lay health worker-led intervention to improve these conversations and reduce unwanted, intensive end-of-life care, and 2) an algorithm-driven approach to identify patients in need of urgent conversations with their clinical teams. This randomized study will evaluate the effectiveness of an intervention combining these two approaches across 7 VA oncology sites. The outcomes include LST documentation, Veteran-reported anxiety and depression, and the identification of factors to inform broad scale of Veteran-centric interventions to improve GoC communication.
Conditions
Conditions (1)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
| Condition (as posted) | Mapped entity | Match | Confidence |
|---|---|---|---|
| Cancer | Malignant Neoplasm | ALIAS | 0.90 |
Interventions
Interventions (2)
| Intervention | Type | Mapped drug | Match |
|---|---|---|---|
| Usual Care | Behavioral | — | UNRESOLVED |
| Usual Care + A-EPAC | Behavioral | — | UNRESOLVED |
Design
Arms and outcomes
Arms (2)
- type
- ACTIVE_COMPARATOR
- label
- Usual Care
- description
- Participants will receive usual cancer care for 12 months or until death whichever is first.
- interventionNames
- Behavioral: Usual Care
- type
- EXPERIMENTAL
- label
- Usual Care + A-EPAC
- description
- Participants will be assigned to a lay health worker who will conduct education sessions over 30-45 minutes by phone initially followed by 15 minute conversations twice monthly for 6 months to discuss goals of care and how to engage in these discussions with their clinical teams. Participants will also receive usual cancer care for a total of 12 months or until death, whichever is first.
- interventionNames
- Behavioral: Usual Care
- Behavioral: Usual Care + A-EPAC
Primary outcomes (1)
Eligibility
Eligibility (as posted)
- Sex
- All
- Minimum age
- 18 Years
Show eligibility criteria text
Inclusion Criteria: * Veteran patients with diagnosis of a solid malignancy with any cancer stage * English or Spanish-speaking * Can self-administer questionnaires in English or Spanish * Valid telephone number * Receiving oncology care at one of 7 sites * Receiving systemic anti-cancer therapy, defined as oral, injection, or intravenous therapy * chemotherapy * hormone therapy * targeted therapy * or immunotherapy defined by the National Cancer Institute A to Z List of Cancer Drugs) * CAN risk score ≥98th percentile (may be adjusted after examining site-level CAN performance) Exclusion Criteria: * No capacity to consent * Actively receiving hospice care
References
Publications (0)
Data not yet available