Oncologist Perceptions of Algorithm-Based Nudges to Prompt Early Serious Illness Communication: A Qualitative Study
Publication: Journal of Palliative Medicine
Volume 25, Issue Number 11
Abstract
Background: Early serious illness conversations (SICs) about goals of care and prognosis improve mood, quality of life, and end-of-life care quality. Algorithm-based behavioral nudges to oncologists increase the frequency and timeliness of such conversations. However, clinicians' perspectives on such nudges are unknown.
Design: Qualitative study consisting of semistructured interviews among medical oncology clinicians who participated in a stepped-wedge cluster randomized trial of Conversation Connect, an algorithm-based intervention consisting of behavioral nudges to promote early SICs in the outpatient oncology setting.
Results: Of 79 eligible oncology clinicians, 56 (71%) were approached to participate in interviews and 25 (45%) accepted. Key facilitators to algorithm-based nudges included prompting documentation of conversations, peer comparisons, performance reports, and validating norms around early conversations. Barriers included cancer-specific heterogeneity in algorithm performance and the frequency and tone of text messages. Areas of improvement included utilizing different information channels, identifying patients earlier in the disease trajectory, and incorporating patient-targeted messaging that emphasizes the value of early conversations.
Conclusions: Oncology clinicians identified key facilitators and barriers to Conversation Connect. These insights inform future algorithm-based supportive care interventions in oncology. Controlled trial (NCT03984773).
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Precis
An algorithm-based behavioral intervention to improve serious illness communication was acceptable and appropriate to oncology clinicians; however, cancer-specific heterogeneity in algorithm performance was a barrier.
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Information & Authors
Information
Published In
Journal of Palliative Medicine
Volume 25 • Issue Number 11 • November 2022
Pages: 1702 - 1707
PubMed: 35984992
Copyright
Copyright 2022, Mary Ann Liebert, Inc., publishers.
History
Published in print: November 2022
Published online: 27 October 2022
Published ahead of print: 18 August 2022
Accepted: 15 July 2022
Authors
Authors' Contribution
Conceptualization, formal analysis, funding acquisition, methodology, resources, writing—original draft, and writing—review and editing by R.P.; conceptualization, and writing—review and editing by C.M.; conceptualization, data curation, formal analysis, methodology, resources, software, writing—review and editing by M.N.; project administration by W.F.; data curation, formal analysis, and methodology by Z.B.; conceptualization, methodology, resources, supervision, and writing—review and editing by J.T., M.P., and J.S.
Author Disclosure Statement
The authors have no conflicts of interest to disclose related to the contents of this article.
Funding Information
The authors are solely responsible for the design and conduct of this study, study analyses, and the drafting of this article. The funders—the National Palliative Care Research Center (NPCRC) and the National Cancer Institute (K08-CA-263541)—played no role in study design, collection, analysis, and interpretation of data, writing of the report, and the decision to submit the article for publication.
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