PROJECT SUMMARY Most advanced cancer patients do not have an accurate understanding of their prognosis and treatment, which interferes with patient-centered, high-quality healthcare. Gaining such information often requires patients to confront stressful clinical discussions while understanding complex medical information. Existing interventions to improve understanding largely target information delivery, without assessing and reducing psychological barriers to hearing prognostic information accurately. This Pathway to Independence Award will equip Dr. Heather Derry with the necessary skills to launch her independent research career, in which she aims to identify and reduce stress-related barriers to informed medical decision-making among patients with cancer. The candidate's prior work suggests that anxiety may reduce patients' accuracy for recently-discussed scan results (used to monitor disease progression and inform treatment). In this career development award, the PI will: (1) solidify targets and methods for a stress management intervention to improve patients' understanding of prognostic information (i.e., scan results), then (2) adapt, revise, and (3) pilot test a stress management program to reduce anxiety prior to key prognostic discussions. At Weill Cornell Medicine's distinguished Center for Research on End-of-Life Care, the PI will receive expert mentorship and complete specialized training in advanced cancer and end-of-life care, intervention adaptation and clinical trials, advanced psychophysiology and statistics, and leadership. In the K99 phase, the PI will conduct an observational study to confirm pilot data linking psychological factors to patient understanding, and investigate vagal tone (measured by heart rate variability) as an underlying physiological mechanism for this pattern. Before an appointment to discuss scan results during first-line treatment, 75 patients with advanced gastrointestinal or lung cancer will complete assessments of resting heart rate and self-reported anxiety, worry, and anticipatory stress. After the appointment, patients will report their understanding of those scan results. Patients' answers will be compared to audio-recorded clinical visits for accuracy. Analyses will test relationships between accuracy, psychological factors, and heart rate variability. Qualitative interviews will elicit patients' preferences for intervention adaptations and delivery methods. In the R00 phase, the PI will use this information to adapt an existing stress management program (a public resource) to mitigate anxiety (and/or other targets) prior to these appointments. Finally, the intervention's feasibility, acceptability, and potential efficacy will be tested in a pilot randomized trial, compared with usual care. Overall, the project will begin to address key psychological and physiological factors missing from prior attempts to improve advanced cancer patients' understanding of prognostic information. Given her prior...