# Communicating the Gist of Prognosis: Giving Information Simply and Transparently ("GIST") in Advanced Cancer

> **NIH NIH R21** · WEILL MEDICAL COLL OF CORNELL UNIV · 2020 · $256,683

## Abstract

Project Summary/Abstract
Despite recent advances in cancer treatments, there still comes a time when the disease progresses, and
patients can reliably be expected to have months, but not years, left to live. Although oncologists can reliably
predict when patients have months to live, and 71% of advanced cancer patients report wanting prognostic
information (with 83% deeming it extremely important), only 17.6% of patients a median of 5 months from
death reported a prognostic discussion with their oncologist. Moreover, only 5% of these patients had accurate
prognostic understanding. Not only does informed, patient-centered, shared decision-making rely on patients'
having a basic understanding of their prognosis, but patients' prognostic understanding has been linked to
significantly better end-of-life outcomes (e.g., less burdensome, unbeneficial care; more palliative and value-
consistent care). Our prior work thus highlights the need for a communication technique that will prove
acceptable to oncologists and that promotes patients' prognostic understanding. To address this need, we
developed the “Giving Information Simply &Transparently” (GIST), Oncolo-GIST intervention -- a manualized
oncologist communication intervention that simplifies how to impart prognostic information by focusing on 4
basic steps: 1) Giving scan information, 2) Informing prognosis, 3) Strategizing sensitively, and 4)
Transparently asking what patients heard. 3 specific aims of the Oncolo-GIST approach will be tested:
USpecific Aim #1:U will obtain feedback on Oncolo-GIST Version 1.0 from stakeholders/key informants (n=10
bereaved caregivers; n=10 oncology clinicians) using a modified Delphi approach. USpecific Aim #2:U will
determine feasibility and acceptability of Oncolo-GIST Version 1.0 in an open trial of 10 advanced cancer
patients. USpecific Aim #3:U will determine whether patients (n=25) meeting with an oncologist randomly
assigned to training in Oncolo-GIST Version 2.0 are more likely than patients receiving usual care (n=25) to
have better prognostic understanding (e.g., report they likely have months to live), our Uprimary outcomeU.
Potential effects on patient: a) engagement in ACP, b) quality of life, receipt of: c) intensive care, d) palliative
care, e) value-consistent end-of-life care, and oncologist-reported: f) satisfaction with prognostic discussions
and g) therapeutic alliance with patients, will be explored. Results will lead to refinements in the Oncolo-GIST
intervention, suggest its clinical feasibility and acceptability, and whether the Oncolo-GIST intervention
promotes patients' prognostic understanding and hypothesized "downstream" effects (e.g., less intensive,
more palliative care, better patient quality of life). Positive results will support the future testing of the Oncolo-
GIST intervention in a multi-site R01 RCT of advanced cancer patients and suggest the potential broader
applicability of this "gist" approach to informed end-of-life decisi...

## Key facts

- **NIH application ID:** 10000146
- **Project number:** 5R21NR018693-02
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Andrew Epstein
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $256,683
- **Award type:** 5
- **Project period:** 2019-08-21 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10000146

## Citation

> US National Institutes of Health, RePORTER application 10000146, Communicating the Gist of Prognosis: Giving Information Simply and Transparently ("GIST") in Advanced Cancer (5R21NR018693-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10000146. Licensed CC0.

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