Home Hematology and Oncology Behavioral Nudges to Prompt Serious Illness Conversations Beneficial

Behavioral Nudges to Prompt Serious Illness Conversations Beneficial

Among patients with cancer, intervention can increase serious illness conversations for all patients and decrease end-of-life systemic therapy

By Elana Gotkine HealthDay Reporter

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.

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