BEACON: BEst Case/Worst Case Adaptation to Communicate with Older oNcology patients

In the next 10-30 years, new cancer diagnoses are projected to double in adults older than 65 and triple in patients older than 80. Because older adults vary in cognitive function, self-care ability, frailty, and comorbidities, these age-related limitations should be considered alongside personal values and community support levels when discussing treatment options for newly diagnosed cancer. This process of shared-decision making (SDM) between patients and their providers has proven to be a successful strategy to elicit better quality of life and health outcomes. However, there is currently a lack of evidence-based guidelines and tools to guide SDM among older adults navigating cancer treatment options, leaving patients, caregivers, and clinicians ill-equipped to facilitate these SDM discussions. This puts some frail older adults at higher risk for treatments that may worsen their overall function, while other healthier individuals are at risk for not receiving guideline-concordant care (GCC).

For several cancers—specifically breast, lung, and rectal—there are many treatment options to consider, but the risks and benefits of GCC compared to alternative treatments are unclear. The options recommended by clinicians can often be more focused on health outcomes or risk level of the treatments, rather than on the goals and values of the patient. This suboptimal SDM experience is even more likely to occur amongst older adults, because of possible differences in healthcare decision-making capacity, and amongst people of color, due to provider bias, language barriers, and cultural differences. One concept linked to increased efficacy in SDM conversations among older adults with cancer is the “Best Case/Worst Case” (BC/WC) approach, which frames treatment decisions along a scale ranging from best to worst possible outcomes.

A project led by PC3I Program Director Lola Fayanju, MD, MA, MPHS, FACS; Karen Glanz, PhD, MPH; Amy Leader, DrPH, MPH; and Nancy Hodgson, PhD, RN, FAAN, combines the BC/WC approach with the comprehensive geriatric assessment (CGA) to increase the rate of SDM conversations and improve communication and care for older adults with cancer . The study team will compare usual care to the combined BEACON (BEst Case/Worst Case Adaptation to Communicate with Older oNcology patients) intervention to discuss treatment, surveillance, and survivorship among older adults newly diagnosed with early-stage lung, breast, and rectal cancer, and through 2 years of follow-up care in community settings. In order to inform the content and approach of the intervention, the team will first plan a series of Community Engagement Studios to engage with older adults with cancer and elicit their feedback on the BC/WC + CGA method and strategy. Through this blending of strategies and engagement with community members in addition to healthcare professionals, this study aims to optimize shared decision-making and communication with older adults diagnosed with cancer. The researchers will conduct a mixed-methods assessment of BEACON using electronic health record data and interviews with subgroups of patients and stakeholders defined by institution, cancer type, age at diagnosis, and race/ethnicity. Interview participants will be identified using deviant sampling to maximize the likelihood of identifying unobservable barriers to BEACON feasibility and effectiveness.

BEACON aims to improve shared-decision making and guideline-concordant care among diverse older patients with early-stage breast, lung, and rectal cancers. Findings from the pragmatic trial and interviews will be used to translate and disseminate the BC/WC and CGA combined methods, tools, and products for use in cancer care and public health practice.

This project is funded by the Centers for Disease Control (CDC) grant (U48-DP006801), which was awarded to the UPenn Prevention Research Center (PRC). The UPenn PRC, founded in 2014, is a community-engaged research center dedicated to improving the health of people in Philadelphia, Southeastern Pennsylvania, and beyond by preventing, reducing, and treating chronic diseases. BEACON is the core research project of the UPenn PRC and one of 20 CDC-funded centers in the 2024-2029 cycle.

Thomas Jefferson University