Reimagine end of life: An online, personalized coping and decision aid for breast cancer patients and providers

Duke School of Nursing
Goal: The goal of the proposed project is to broaden the horizons of the Seven Pillars of Personal Strength™ curriculum and demonstrate that shared decision making (SDM) and end of life (EOL) care knowledge can be improved. Specifically, we aim to: 1) determine the feasibility of metastatic breast cancer (MBC) patient, caregiver, and provider engagement in SDM through participation in Reimagine’s Worries to Wishes Program; and 2) demonstrate whether Reimagine influences patient, caregiver, and provider EOL care knowledge, SDM, and quality of life. 
Target population: Patients with MBC, caregivers, and oncology providers.
Methods: Breast cancer patients with metastatic disease will be identified using DEDUCE inquiries of electronic health records (EPIC), recruited from Duke Cancer Center clinics and hospitals, and randomized to treatment or a waitlisted control arm. Consenting participants will meet with a certified Pillar Guide in separate patient/caregiver or provider online group meetings. Short videos are viewed and guided activities completed at leisure so that class time is focused on discussion. Roger’s Diffusion of Innovations framework will be used to describe program adoption and dissemination.
Assessment: Electronic assessments at baseline and post-intervention (9 and 18 weeks) with validated instruments are used to determine changes in outcomes. Descriptive analysis will be used to summarize process-related measures such as advance directive completions and program usage (i.e., examine feasibility). Independent sample t-tests will be used to examine changes in outcomes. Multiple regression will be conducted to estimate the relationships between the SDM variable and the outcome measures.  
Full ProposalInterim ReportsFinal Report
Approval Date:
July 2016
Amount Awarded:
Start Date:
End Date:
Metastatic Breast Cancer