Patient-oncologist Discussion of Treatment Decisions: Exploring the Role of a Patient-Centered Communication Tool for Older Adults with Acute Myeloid Leukemia and Their Caregivers.

Acute myeloid leukemia (AML) is a disease of aging. Outcomes for older adults are poor, and a substantial proportion do not receive cancer-directed treatment [ 1 Lancet J.E. Is the overall survival for older adults with AML finally improving?. Best Pract Res Clin Haematol. 2018; 31: 387-390 Crossref PubMed Scopus (26) Google Scholar , 2 Medeiros B.C. Satram-Hoang S. Momin F. et al. Real-world treatment patterns and comparative effectiveness among a population of elderly patients with acute myeloid leukemia (AML). Blood. 2018; 132: 835https://doi.org/10.1182/BLOOD-2018-99-111267 Crossref Google Scholar , 3 Kennedy V.E. Keegan T.H.M. Li Q. et al. Frontline treatment patterns and outcomes among older adults with acute myeloid leukemia: a population-based analysis in the modern era. Cancer. 2022; 128: 139-149 Crossref Scopus (4) Google Scholar , 4 Thein M.S. Ershler W.B. Jemal A. et al. Outcome of older patients with acute myeloid leukemia. Cancer. 2013; 119: 2720-2727 Crossref PubMed Scopus (158) Google Scholar ]. Older adults with AML find treatment decisions overwhelming due to the sudden nature of the disease, lack of disease understanding, confusion about their treatment options, and inadequate communication from their oncology care provider [ [5] LeBlanc T.W. Fish L.J. Bloom C.T. et al. Patient experiences of acute myeloid leukemia: a qualitative study about diagnosis, illness understanding, and treatment decision-making. Psycho-Oncology. 2017; 26: 2063-2068 Crossref PubMed Scopus (70) Google Scholar ]. Comorbid medical conditions and poor performance status are associated with treatment tolerability, and considering patient characteristics may help inform selection of appropriate treatments [ [6] Abdallah M. Xie Z. Ready A. et al. Management of Acute Myeloid Leukemia (AML) in older patients. Curr Oncol Rep. 2020; 22: 103 Crossref PubMed Scopus (15) Google Scholar , [7] Nagl L. Koinig K. Hofer F. et al. Comorbidities cluster with impaired functional capacities and depressive mood and predict adverse outcome in older patients with hematological malignancies. Leuk Lymphoma. 2020; 61: 1954-1964 Crossref Scopus (5) Google Scholar ]. However, few studies have described how such factors are incorporated into discussions of treatment options for older adults with AML in real-world clinical practice. We previously developed a patient-centered communication tool, University of Rochester-Geriatric Oncology Assessment for acute myeloid Leukemia (UR-GOAL), to promote shared decision-making between patients and their oncologists [ [8] Watson E. Sanapala C. Cortes A.M. et al. Adapting a patient-centered communication tool for older patients with acute myeloid leukemia and their oncologist. Blood Adv. 2022; 6: 5707-5710 Crossref PubMed Scopus (5) Google Scholar ]. In this study, we analyzed clinical encounters informed by the UR-GOAL tool to qualitatively describe how treatment options were discussed between older adults, caregivers, and their oncologists.