# Communicating the Gist of Prognosis: An intervention to improve prognostic understanding in advanced lymphoma

> **NIH NIH R21** · SLOAN-KETTERING INST CAN RESEARCH · 2022 · $274,411

## Abstract

PROJECT SUMMARY
Prognostic understanding is vital to advanced cancer patients’ ability to receive end-of-life (EOL) care
consistent with their preferences. Advanced cancer patients who have an accurate prognostic understanding
are more likely to engage in advance care planning (ACP; e.g. do-not-resuscitate order), prefer comfort care
over intensive care, receive care consistent with their preferences, and die in their preferred place of death.
Research on prognostic understanding has largely focused on white patients with advanced solid tumors. This
gap is notable due to the unique disease trajectory of advanced lymphoma. While the initial treatment goal is
cure, prognosis suddenly and dramatically worsens following disease progression with the majority of patients
nearing death. Less than half of patients with a hematologic malignancy have an accurate understanding of
their prognosis or engage in ACP and hematologic malignancy patients are more likely to receive intensive
EOL care than solid tumor patients. Further, black patients have higher rates of poor prognostic understanding
and burdensome intensive EOL care and are less likely to engage in ACP than white patients. The low rates of
ACP and high rates of intensive EOL care in patients with hematologic malignancies, especially black patients,
point to a need for interventions to improve prognostic understanding and reduce racial disparities in ACP. The
purpose of this project is to refine and pilot test a communication intervention to improve black and white
advanced lymphoma patient prognostic understanding and engagement in ACP. The goals of this study are to:
(1) develop a culturally appropriate communication intervention to improve hematologists’ ability to clearly
communicate to black and white patients about prognosis; (2) evaluate the feasibility and acceptability of the
intervention among hematologists and black and white advanced lymphoma patients; and (3) test the pre-post
effect of the intervention on black and white patient prognostic understanding (primary outcome), engagement
in ACP, completion of advance directives, quality of life, patient and hematologist communication satisfaction,
and patient-hematologist agreement on the patient’s healthcare values (secondary outcomes). To meet these
goals, we will conduct focus groups with hematologists (n=16) and black and white advanced lymphoma
patients (n=32) to improve the intervention. Next, we will pilot test the intervention with n=8 hematologists and
n=40 patients and assess outcomes at baseline, post-intervention, and three months later to examine the
feasibility, acceptability, and pre-post effect of the intervention. These results will inform a NIH R01 application
to conduct a large-scale randomized controlled trial of intervention efficacy. Grounded in the established Fuzzy
Trace Theory, the present study takes the novel approach of targeting information processing strategies used
during decision making. This project will fo...

## Key facts

- **NIH application ID:** 10526566
- **Project number:** 1R21MD017704-01A1
- **Recipient organization:** SLOAN-KETTERING INST CAN RESEARCH
- **Principal Investigator:** Kelly McConnell
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $274,411
- **Award type:** 1
- **Project period:** 2022-09-25 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10526566

## Citation

> US National Institutes of Health, RePORTER application 10526566, Communicating the Gist of Prognosis: An intervention to improve prognostic understanding in advanced lymphoma (1R21MD017704-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10526566. Licensed CC0.

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