Giving information strategically and transparently - A pilot trial of the Oncolo-GIST intervention to promote patients' prognostic understanding

Q: What problem does the Oncolo-GIST intervention address?

Most cancer patients lack prognostic understanding needed to make informed end-of-life decisions. The intervention aims to improve that understanding.

Q: How was prognostic understanding measured in this pilot trial?

Prognostic understanding was assessed within a week of the scan discussion visit, including patient-reported understanding such as life expectancy in months versus years.

Q: Did Oncolo-GIST affect patients’ anxiety, depression, or therapeutic alliance?

The study found no statistically significant differences between groups for therapeutic alliance, anxiety, or depression scores.

Sep 24, 2026

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Purpose: Most patients with cancer lack prognostic understanding needed to make informed decisions. The study tested feasibility and acceptability of the Oncolo-GIST intervention and examined associations with improved prognostic understanding. Methods: Oncolo-GIST transforms prognostic discussions into easy-to-understand talking points. Patients with metastatic cancers progressing on ≥1 chemotherapy line and not expected to survive 12 months (n=31) were recruited from Oct 2020 to Nov 2022 and compared with usual care. Outcomes included prognostic understanding assessed within a week. Results: Oncologists appeared receptive and scored nearly perfectly after a <2-hour tutorial. After the visit, 100% of patients in the Oncolo-GIST group understood incurability, with improvements versus usual care. Conclusion: Oncolo-GIST may improve prognostic understanding without undermining alliances or increasing anxiety or depression; larger efficacy testing is warranted.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Purpose

Methods

Results

Conclusion

Introduction

Background on prognostic understanding

Impact of prognostic awareness on care

DOI: 10. 1002/cam4 .6420 RESEAR CH ARTICLE Giving information strategically and transparently: A pilot trial of the Oncolo-GIST intervention to promote patients' prognostic understanding Holly G. Prigerson1,2 | David Russell3 | Sophia E. Kakarala1,2 | Heather M. Derry-Vick4 | Manish A. Shah5 | Ashish Saxena5 | Valerie F. Reyna6 | Allyson Ocean5 | Ronald Scheff5 | Paul K. Maciejewski1,2,7 | Andrew S. Epstein8 1Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA 2Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA 3Department of Sociology, Appalachian State University, Boone, North Carolina, USA 4Hackensack Meridian School of Medicine, New Jersey, USA 5Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA 6Cornell University, Human Neuroscience Institute, Ithaca, New York, USA 7Department of Radiology, Weill Cornell Medicine, New York, New York, USA 8Memorial Sloan Kettering Cancer Center, New York, New York, USA Correspondence Holly G. Prigerson, Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 420 East 70 Street, Suite 3B, Room 321, Lasdon House, New York City, NY 10021, USA. [Email:](Email: hgp2001@med.cornell.edu)[ hgp2001@med.cornell.edu](Email: hgp2001@med.cornell.edu) Funding information National Cancer Institute, Grant/ Award Number: CA197730 (Prigerson); National Institute of Minority Health and Health Disparities, Grant/ Award Number: MD017704 (Trevino/ Prigerson); National Institute of Nursing Research, Grant/Award Number: NR018693 (Prigerson/ Epstein) Abstract Purpose: Most patients with cancer lack the prognostic understanding necessary to make informed decisions. We tested the feasibility and acceptability of the Oncolo-GIST (“Giving Information Strategically and Transparently, GIST”) intervention and explored its associations with patients' improved prognostic understanding. Methods: The Oncolo-GIST intervention distills prognostic discussions into easyto-understand talking points. Patients with metastatic cancers that progressed on ≥1 line of chemotherapy and not expected to survive 12 months (n = 31) were recruited from October 2020 through November 2022. We compared patients who discussed their progressive scans with an oncologist trained in the GIST technique or not (i.e., usual care). A primary outcome was prognostic understanding (e.g., patients reporting a life-expectancy of months) assessed within a week of the scan discussion visit. Results: Oncologists (n = 4) appeared receptive to the Oncolo-GIST intervention and scored nearly perfectly on post-training tests of material mastery after a <2-h tutorial. Post-scan discussion visit, 100% of patients who met with an OncoloGIST-trained clinician understood that their cancer was considered incurable (a 31% improvement from pre-visit) compared with 91% of patients meeting with This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. usual care oncologists (an 18% improvement); 33% of patients who met with an Oncolo-GIST-trained oncologist understood that they likely had months, not years, compared to 18% in the usual care group. No statistically significant differences emerged for these changes, nor for therapeutic alliance, anxiety, or depression scores between groups. Conclusion: Oncolo-GIST appears to be an easily learned approach to improve prognostic understanding that neither undermines therapeutic alliances nor increases patients' anxiety or depressive symptoms. Efficacy testing in a larger trial is warranted. KEYWORDS cancer, communication intervention, prognostic understanding,

FAQs

What problem does the Oncolo-GIST intervention address?

Most cancer patients lack prognostic understanding needed to make informed end-of-life decisions. The intervention aims to improve that understanding.

How was prognostic understanding measured in this pilot trial?

Prognostic understanding was assessed within a week of the scan discussion visit, including patient-reported understanding such as life expectancy in months versus years.

Did Oncolo-GIST affect patients’ anxiety, depression, or therapeutic alliance?

The study found no statistically significant differences between groups for therapeutic alliance, anxiety, or depression scores.

Sep 24, 2026

Uploaded by Cart