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A four-arm randomized trial published in the Journal of the National Comprehensive Cancer Network examined whether targeted prompts increased the documented number of serious illness conversations between oncologists and patients with advanced cancer. The study, known as PATH-SIC, was conducted at the Dana-Farber Cancer Institute and included more than 1,000 patients who began treatments associated with a poor prognosis. Researchers compared four approaches: a reminder email sent to clinicians before a visit; a letter and questionnaire mailed to patients; both prompts together; or neither prompt.
Patients in the combined-prompt group had 79% higher odds of a documented serious illness conversation within 60 days than patients who received no prompt. Each prompt used alone was associated with a smaller increase that did not reach statistical significance. The researchers reported that much of the combined effect appeared to be related to the clinician reminder. Even with both prompts, serious illness conversations were documented for about one-third of patients.
For health plans and value-based oncology programs, the findings may be relevant to quality measurement and care management efforts. Documented advance care planning and serious illness conversations are included in some quality frameworks and have been associated in prior research with care that aligns with patient goals and with less intensive treatment near the end of life. The interventions tested in the trial—an email prompt and a mailed letter—were relatively low intensity and could be incorporated into targeted outreach workflows. Because the trial focused on patients with a poor prognosis, the approach may be applicable to risk-based outreach using claims or electronic health record data.
The study also identified limits to prompt-based interventions. Researchers restricted prompts to patients starting poor-prognosis therapy and capped the number of visits at three to reduce the risk of alert fatigue. The findings suggest that targeted reminders may increase documentation rates, but the remaining gap indicates that additional support may be needed to increase the frequency of serious-illness conversations. For health plans, the results indicate that prompts are a potential component of broader oncology care management strategies.
