# Enhancing Triadic Communication About Cognition for Older Adults with Alzheimer's Disease or Related Dementias Facing a Cancer Management Decision

> **NIH NIH R01** · UNIVERSITY OF ROCHESTER · 2022 · $422,773

## Abstract

Project Summary: The overarching goal of this proposal, submitted in response to RFA-AG-22-020, is to
adapt an existing communication tool developed by our team for use in patients with Alzheimer’s Disease or
Related Dementias (ADRD) and their care partners, and to evaluate if this tool can enhance communication
about cognition in the context of a cancer management decision. This proposal is important because
approximately 7% of older adults diagnosed with cancer have pre-existing dementia. For older adults with
ADRD and cancer, medical decision making is more complex, and integrates information about the risks and
benefits of potential interventions in the context of the dual diagnoses. Limited data are available to guide the
“best” approach and thus, relies on discussions about the risks and benefits of options in the context of patient
and care partner goals and preferences. Unfortunately, there is no standard approach among oncology
clinicians as to how to discuss cognition in the context of a cancer management decision for patients with pre-
existing ADRD and their care partners. Preliminary research by the PI (Magnuson) and team suggest that
cognitive impairment is prevalent in older patients with cancer and that a geriatric assessment-based
communication tool can facilitate conversations about aging-related conditions, such as cognition, with older
patients and their care partners. However, the intervention was not tested in patients with ADRD and did not
address patient and care partner concerns about cognition in the context of cancer. Adapting this tool for
patients with ADRD (adapted tool called “COACH-Cog”) may improve both care partner and patient outcomes
through greater acknowledgement and support of cognitive concerns and cognitive-related goals, thereby
improving goal concordant care. COACH-Cog adaptations will include: 1) brief, focused training for oncology
clinicians about ADRD in the context of cancer and communication training to navigate the triadic nature of
these conversations, thereby enhancing oncology clinician knowledge and supporting their decision processes;
and 2) care partner and patient Communication Coaching and Question Prompt List providing knowledge,
skills, and behavioral cueing for discussing their cognitive concerns and cognitive-related goals with oncology
clinicians. Focus groups with key stakeholders will guide the adaptation. Subsequently, we propose to conduct
a pilot, Stage I RCT (cluster randomized at physician) with older adults with a clinical diagnosis of ADRD and
their care partners (N=130 dyads) to evaluate the preliminary efficacy of COACH-Cog on care partner and
patient autonomy support, care partner well-being, and goal concordance in outcomes at 3 months. Our
uniquely qualified, multidisciplinary team includes expertise in geriatric oncology, cognition, behavioral
neurology, intervention development, communication science, biostatistics, palliative care, and care partner
research. This inno...

## Key facts

- **NIH application ID:** 10436554
- **Project number:** 1R01AG077053-01
- **Recipient organization:** UNIVERSITY OF ROCHESTER
- **Principal Investigator:** Allison Marian Magnuson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $422,773
- **Award type:** 1
- **Project period:** 2022-05-15 → 2027-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10436554

## Citation

> US National Institutes of Health, RePORTER application 10436554, Enhancing Triadic Communication About Cognition for Older Adults with Alzheimer's Disease or Related Dementias Facing a Cancer Management Decision (1R01AG077053-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10436554. Licensed CC0.

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