Photo Credit: Nemes Laszlo
The following is a summary of “Protocol of a decisional intervention for older adults with newly diagnosed acute myeloid leukemia and their caregivers: UR-GOAL 3,” published in the January 2025 issue of Oncology by Loh et al.
Therapeutic advancements have enabled a growing number of adults aged ≥60 years with acute myeloid leukemia (AML) to receive life-prolonging treatments, resulting in improved overall survival. Unlike many cancers, AML often presents abruptly, necessitating urgent, high-stakes treatment decisions. The prognosis for older adults with AML is frequently compromised by aging-related factors, such as functional impairments, which complicate treatment outcomes. Studies reveal that up to 78% of older adult patients with AML and their caregivers experience substantial psychological distress, which adversely impacts quality of life, increases healthcare utilization, and raises mortality risk. SDM is a critical tool to alleviate distress, enhance patient and caregiver engagement, and achieve goal-concordant care. Despite its potential, interventions to optimize SDM and reduce distress in this vulnerable population remain underexplored.
To address this gap, researchers propose a multicenter randomized controlled trial to assess the efficacy of the University of Rochester-Geriatric Oncology Assessment for Acute Myeloid Leukemia (UR-GOAL) in reducing distress and enhancing SDM among older adult patients with AML, their caregivers, and oncologists. The trial will recruit 300 patients aged ≥60 years with newly diagnosed AML, their caregivers (if available), and up to 40 oncologists from four institutions. The intervention involves three components: Patients will watch an educational video about AML diagnosis, treatment, and prognosis; complete a values clarification process using Best Worst Scaling; and review a personalized summary report containing tailored questions and resources. Caregivers will engage in the same educational and reporting process as the patients. Oncologists will review a report summarizing the patient’s aging-related conditions, prognosis perceptions, and values. During clinical visits, patients, caregivers, and oncologists will discuss these factors to reach an informed treatment decision.
The primary outcome measure is distress, assessed using the Distress Thermometer. Secondary outcomes include observed SDM, patient-perceived SDM, and decisional conflict.
This trial seeks to bridge critical knowledge gaps by demonstrating how patient-centered, evidence-based interventions can reduce psychological distress and decisional conflict while promoting effective SDM in older adult patients with AML. Successful implementation of the UR-GOAL framework may serve as a model for developing decision-support tools in broader oncology populations.
Source: sciencedirect.com/science/article/abs/pii/S1879406825000037
