Dr. Kevin Rand, a psychology professor in the School of Science at IUPUI, and Dr. Larry Cripe, a professor of medicine and oncologist at the IU Simon Cancer Center, have launched a two-year, $330,000 American Cancer Society funded study to examine those questions. The project is titled “Goal-related thoughts & end-of-life decisions in advanced cancer patients.”
The focus of the study will be some 60 patients who have been diagnosed with advanced lung or gastro-intestinal cancer, Rand said. The median life expectancy of these patients is less than a year.
“We are interested in understanding how these patients make treatment decisions as they go through their care and how their thoughts about the goals they have for their life and for their health care change over the course of their illness and how these goals predict treatment decisions, especially as they get close to the end of their lives,” Rand said. “Do they choose to enroll on hospice, or get aggressive treatments such as chemotherapy even though they may have been told it is unlikely to benefit them? What do their goals predict as to their health care choices? Are they getting health care in line with their goals?”
Patients will be interviewed twice, three or four months apart. Each time, they will be asked to list their life goals and treatment goals.
Among the questions: What are your most important goals? Patients will also be asked how they would invest their time and energy in pursuing those goals.
“We want to see if the goals of the patients change over time and if those changes relate to the progress of their disease or treatment,” Rand said.
Whether patients are making decisions and then receiving treatment that is in line with their goals isn’t really known, Rand continued. “If the answer is yes, that’s great. But if not, we want to know why not. There are lots of reasons why that might not happen. Health care providers may not be aware of the goals as well as they should be, or the goals may be so dynamic and changing that it would be hard for the treatment they receive to be in line with the goals because they are in flux.”
The study itself has an ultimate goal. “We want to design an intervention for health care providers so that everyone understands what the goals of the patient are and to help ensure patient care is in line with those goals.”
According to Rand, the two-year study will demonstrate the feasibility of gathering necessary information from patients who may be near the end of their lives. The next step would be to engage in a longer term study involving a larger number of patients.