INtegrating Systematic PatIent-Reported Evaluations in Multi-Disciplinary Tumor Boards for Pancreatic Cancer

Abstract public domain (NIH RePORTER)

Project Summary: Treatment of pancreatic cancer often entails multi-modal strategies that vary substantially in intensity, with the most aggressive treatment approach only recommended for the most `fit' patients, regardless of age. Tools exist to capture these domains, including electronic patient reported outcome (ePRO-) versions of preference elicitation tools and the geriatric assessment (GA: systematic evaluation of multi-dimensional func- tional limitations), which are known to improve patient outcomes. However, in practice, patient fitness assess- ment remains largely subjective and patient preferences are rarely discussed. A promising approach to address this gap entails the inclusion of ePROs within multidisciplinary tumor board (MDTB) discussions. In our INSPIRE (INtegrating Systematic PatIent-Reported Evaluations in Multi-Disciplinary Tumor Boards for Pancreatic Cancer) pilot, we demonstrated that presentation of combined data from ePRO-based GA and preference elicitation tools was feasible and acceptable. Furthermore, INSPIRE increased discussions of objective (94% vs. 0%) and sub- jective fitness (59% vs. 42%), comorbid conditions (88% vs 77%), and patient preferences (76% vs. 10%). IN- SPIRE patients had fewer treatment modifications (54% vs. 68%), emergency room (ER) visits (34% vs 42%), and hospitalizations (33% vs. 50%) at 6 months compared with historic control patients. This pilot study high- lighted the promise of INSPIRE, while underscoring the need for randomized trials to assess the impact of IN- SPIRE on patient outcomes across populations, particularly for groups facing challenges related to psychosocial concerns, comorbid conditions, and communication gaps. We hypothesize that the INSPIRE intervention will improve patient-centricity of MDTB discussions, as well as clinical and patient-reported outcomes. We will test this hypothesis in a randomized control trial that evaluates the direct and indirect impact of the INSPIRE inter- vention on: (1) MDTB discussion content; (2) treatment modifications, treatment intensity, and healthcare utili- zation, and (3) patient-reported outcomes. In Aim 1, we will qualitatively analyze recordings of MDTBs and con- duct semi-structured interviews with participating providers regarding intervention impact and burden. In Aim 2, we will assess the impact of INSPIRE on alignment of treatment with patient fitness levels, as well as downstream treatment modifications and healthcare utilization. In Aim 3, we will evaluate intervention effects on patient acti- vation, perception of shared decision-making, decision satisfaction, decision regret, symptom burden, and quality of life. This project is innovative as the first study to evaluate the impact of ePRO inclusion within MDTBs and offers a novel and systematic approach to ensuring ePRO integration into clinical practice. The proposed re- search is significant, as we expect INSPIRE to result in more patient-centric discussions, treatment aligned with fitness and patient preferences, and enhanced clinical outcomes. This research represents a key step toward routine implementation of ePROs, including the GA and patient preferences, into decisions when developing individualized treatment plans for individuals with cancer.

Public health relevance public domain (NIH RePORTER)

Project Narrative: The proposed research is relevant to public health by improving cancer treatment decision-making processes in a complex and dynamic cancer treatment context by evaluating the impact of integrating electronic patient-re- ported outcomes into patient presentations within multidisciplinary tumor boards for individuals with pancreatic cancer. This research will significantly advance the field's knowledge of how to integrate patient-reported out- comes data into clinical care and determine the efficacy of this approach on patients' treatment alignment with NCCN guidelines and downstream patient outcomes. While expected to benefit all adults with pancreatic cancer, this intervention may particularly impact key populations by improving clinician awareness of psychosocial fac- tors, objective fitness assessments, comorbid conditions, and preferences for treatment, which may be less clearly expressed for some populations; thus, the proposed research is particularly relevant to the NIH's mission to help people live longer, healthier lives through NCI's mission to treat cancer.