A coping and communication support intervention tailored to older patients diagnosed with late-stage cancer

Figures & data

Figure 1 Conceptual framework.

Table 1 Advanced cancer patients’ demographic characteristics at intake

	Middle-age 40–60 years n = 82		Young-old 61–80 years n = 79		p-value
	N or mean	(% or sd)	N or mean	(% or sd)
Age
Mean age (sd)	53.40	5.26	68.51	6.02	0.000
Gender
Male	51	62.0%	59	74.7%	0.094
Female	31	37.8%	20	25.3%
Race
White	40	48.8%	50	63.3%	0.131
African American	38	46.3%	28	35.4%
Other	4	4.9%	1	1.3%
Income*
$0 - $9,999	21	26.3%	16	22.2%	0.167
$10,000 - $14,999	14	17.5%	20	27.8%
$15,000 - $19,999	8	10.0%	15	20.8%
$20,000 - $29,999	15	18.8%	9	12.5%
$30,000 - $39,999	8	10.0%	7	9.7%
$40,000 - $49,999	6	7.5%	2	2.8%
$50,000 or more	8	10.0%	3	4.2%
Marital status
Single	18	22.0%	2	2.5%	<0.0001
Married/Partner	28	34.1%	43	54.4%
Separated/Divorced	31	37.8%	24	30.4%
Widowed	5	6.1%	10	12.7%
Formal education
Mean Years (sd)	12.32	2.3	12.33	2.5	0.975
Insurance
Medicare only	4	4.9%	9	11.4%	0.155
Medicaid only	36	43.9%	15	19.0%	0.000
Private health insurance	15	18.3%	17	21.5%	0.694
Medicare + medicaid	8	9.8%	22	27.8%	0.004
Medicare + private insurance	1	1.2%	10	12.7%	0.004
Not insured	18	22.0%	6	7.6%	0.024

* Sample size varies due to missing values

Table 2 Advanced cancer patients’ physical and psychosocial characteristics

	Middle-age 40–60 years n = 82		Young-old 61–80 years n = 79		p-value
	mean	(sd)	mean	(sd)
Physical status
Total comorbid conditions	1.35	1.5	2.01	1.6	0.007
Symptom distress scale	30.28	9.1	24.98	6.5	0.001
Possible range 13–52
Functional status
ADL limitations	0.99	1.3	0.73	1.2	0.199
Possible range: 0–7
IADL limitations	2.78	3.2	1.99	3.2	0.124
Possible range: 0–21
Psychosocial status
Distress thermometer	4.99	2.8	3.49	2.7	0.001
Possible range: 0–10
POMS anxiety	9.01	6.4	5.64	5.3	0.000
Possible range: 0–24
POMS depression	10.41	8.6	5.72	6.8	0.000
Possible range: 0–32
Health information processing style (MBSS short form)
MBSS monitoring	5.32	1.8	5.06	1.9	0.408
Possible range: 0–8
MBSS blunting	3.85	1.8	3.72	1.7	0.631
Possible range: 0–8

Table 3 Context of initial care conference

	Middle-age 40–60 years n = 82		Young-old 61–80 years n = 79		p-value
	N or mean	(% or sd)	N or mean	(% or sd)
Setting of initial care conference
Patient’s home	43	54.4%	50	64.9%	0.308
Family member’s home	8	10.1%	7	9.1%
Cancer clinic*	20	25.3%	11	14.3%
Other location in hospital*	5	6.3%	8	10.4
Other**	3	3.8%	1	1.3%
Length of initial conference
Mean minutes (sd)	92.7	40.3	92.4	42.8	0.964
Weeks from diagnosis to initial care conference
Mean weeks (sd)	14.5	11.7	16.3	14.5	0.406

* Veterans Affairs Medical Center (VAMC) or MetroHealth Medical Center (MHMC).

** Long Term Care Facility or Cafe.

Table 4 Advanced cancer patients’ problems and preferences in initial care conference

	Middle-age 40–60 years n = 82		Young-old 61–80 years n = 79		p-value
	N	(%)	N	(%)
Problems domains raised in initial care conference*
Respondents who identified one or more problems	80	97.6%	76	96.3	0.490
Number of patients (%) who identified problems
Symptom issues	77	96.3%	72	93.5%	0.490
Psychological problems	67	82.7%	61	77.2%	0.433
Practical problems	66	81.5%	54	68.4%	0.068
Communication with family/friends	49	60.5%	26	32.9%	0.000
Existential Problems	45	55.6%	48	60.8%	0.525
Communication with health care providers	41	50.6%	49	62.0%	0.155
Caregiver Burden	1	1.2%	2	2.5%	0.618
Patient preferences for follow-up engagement in the intervention
Preference for follow-up initiator, N (%)
Patient	6	7.4%	6	7.7%	0.664
Family caregiver	0	0.0%	2	2.6%
CCS practitioner	70	86.4%	64	82.1%
Other**	5	6.2%	6	7.7%
Preference for follow-up method, N (%)
Phone	76	95.0%	73	94.8%	0.410
In person	3	3.8%	1	1.3%
E-mail	1	1.3%	3	3.9%
Preference for follow-up frequency, N (%)
Daily	2	2.5%	0	0.0%	0.522
Two or three times each week	3	3.8%	3	3.9%
Weekly	22	27.5%	15	19.5%
Every two weeks	36	45.0%	36	46.8%
Monthly	11	13.8%	17	22.1%
Other**	6	7.5%	6	7.8%

* Missing values for 1 respondent.

** Unsure, as needed, not often.

Table 5 Characteristics of patient contacts in first six weeks after initial care conference

	Middle-age 40–60 years n = 82		Young-old 61–80 years n = 79		p-value
Contacts	N or mean	(% or sd)	N or mean	(% or sd)
Number of patient contacts
Mean number of contacts (sd) (Range)	3.83 (1–28)	4.4 (1–12)	2.97	2.3	0.129
Length of contacts
Mean number of minutes (sd)	10.63	9.1	9.85	10.9	0.640
Frequency of patient contacts
> 12 Contacts (eg, daily), N (%)	2	2.4%	0	0.0%	0.375
8–12 Contacts (2/3 per week), N (%)	3	3.7%	3	3.8%
5–7 Contacts (weekly), N (%)	20	24.4%	15	19.0%
3–4 Contacts (bi-weekly), N (%)	20	24.4%	21	26.6%
1–2 Contacts (monthly), N (%)	28	34.1%	36	45.6%
0 Contacts (eg, other), N (%)	9	11.0%	4	5.1%
Proportion of contacts by mode
Phone, mean (sd)	0.91	0.19	0.92	0.21	0.742
Clinic visit, mean (sd)	0.08	0.19	0.08	0.21	0.637
E-Mail, mean (sd)	0.01	0.06	0.00	0.00	0.312
Proportion of contacts by initiator
CCS practitioner, mean (sd)	0.89	0.24	0.82	0.33	0.105
Patient, mean (sd)	0.05	0.17	0.11	0.27	0.082
Family caregiver, mean (sd)	0.02	0.09	0.01	0.06	0.438
Other, mean (sd)	0.02	0.06	0.02	0.12	0.823

Table 6 Problem domains raised and intervention strategies used in first six weeks after initial care conference

	Middle-age 40–60 years n = 82		Young-old 61–80 years n = 79		p-value
	N	(%)	N	(%)
Problems identified in first six weeks
Respondents who identified one or more problems	69	84.1%	72	91.1%	0.234
Number of respondents (%) who identified specific problems
Symptom issues	63	76.8%	65	84.8%	0.233
Practical problems	51	62.2%	31	39.2%	0.005
Psychological problems	41	50.0%	31	39.2%	0.205
Communication with health care providers	27	32.9%	27	34.2%	0.869
Communication with family/friends	27	32.9%	11	13.9%	0.005
Existential problems	25	30.5%	14	17.7%	0.067
Caregiver burden	1	1.2%	0	0.0%	–
Interventions used in first six weeks
Number of patients (%) for whom each intervention strategy was used
Supportive listening	69	84.1%	71	89.9%	0.352
Cognitive/problem solving	50	61.0%	41	51.9%	0.269
Education/handouts provided	47	58.0%	45	58.4%	1.000
Validation*	17	20.7%	17	21.5%	1.000
Case navigation	15	18.3%	13	16.5%	0.837
Referral	15	18.3%	7	8.9%	0.108
Behavioral	14	17.1%	8	10.1%	0.253
Web guidance**	0	0.0%	0	0.0%	–

* This strategy was added to documentation after the first year of enrollment, based on observed need.

** 17% of middle-aged and 22% of young-old patients reported having access to the internet.