Improving decision-making for older adults with melanoma

PROJECT SUMMARY/ABSTRACT: Older adults account for over half of new cases of melanoma each year, but healthcare providers face significant challenges when deciding on appropriate treatment for these patients. Evidence is limited on the benefits and harms of treatment for older adults with melanoma because they were underrepresented in recent

landmark clinical trials in melanoma. Effective shared decision-making is also needed to elicit the unique preferences of older adults and provide personalized treatment recommendations, but healthcare providers routinely fail to understand patient preferences when practicing routine shared decision-making. The

combination of uncertain evidence and ineffective shared decision-making leaves older adults with melanoma vulnerable to over and undertreatment. In this setting, older adults with melanoma would benefit from improving the quality of evidence and implementing effective shared decision-making. “Improving decision-making for older adults with melanoma” is a two-year R03 that responds

specifically to AG-24-047 for “transdisciplinary aging research that will yield pilot data and experience for subsequent aging research projects.” This proposal serves the long-term goals of aligning treatment decisions with patient preferences, maximizing use of beneficial treatments, and minimizing unwanted or

ineffective treatments for older adults with melanoma. The objective for this proposal is to inform and adapt the “Better Conversations” framework for shared decision-making for older adults with melanoma. This project has two aims: Aim 1, to characterize healthcare trajectories of older adults with melanoma to inform the discussion

of goals and downsides of treatment in the “Better Conversations” framework; Aim 2, to adapt the “Better Conversations” framework for treatment discussions with older adults with melanoma. The results of this proposed work will guide treatment discussions for older adults with melanoma. Upon

completion of this study, we will be well-positioned to perform a pilot study evaluating an intervention to teach melanoma oncology providers to use the adapted “Better Conversations” framework for older adults with melanoma.