Predictors of Engagement in a Coping and Communication Support Intervention for Older Patients with Advanced Cancer

OBJECTIVES To examine patterns and predictors of engagement in a coping and communication support (CCS) intervention tailored to the preferences of middle-aged and older patients in the early treatment phase for late-stage cancer. DESIGN Randomized controlled trial examining processes and outcomes of a CCS intervention for patients with late-stage cancer over time. SETTING Two ambulatory cancer clinics providing care for underserved populations in Cleveland. PARTICIPANTS One hundred nine middle-aged (MA: aged 40-60) and 101 young-old (YO: aged 61-80) patients randomized to the CCS intervention, surviving to 3 months after enrollment and averaging 2 months of 24/7 access to the intervention. MEASUREMENTS Engagement was assessed in the average number of patient-CCS practitioner (CCSP) contacts per month during the initial 2 months of access to the intervention. Baseline data from patient interviews and chart reviews were used to test a model of prediction. RESULTS MA patients averaged more patient-CCSP contacts per month than YO patients (mean 2.6 +/- 2.5 vs 2.0 +/- 1.2, P=.02), although both age groups were engaged. African-American patients (P=.007) and those with a higher blunting style (P <.01), reporting more family discord in cancer communication (P=.009), and receiving fewer active cancer treatments (P=.008) were more engaged in the CCS intervention in the initial months. CONCLUSIONS Psychooncology interventions individualized to patient preferences can effectively reach older and underserved populations. Such interventions may be especially important to patients using more avoidant behaviors, experiencing more family discord communicating about cancer, or receiving fewer aggressive treatments in the early treatment phase for late-stage cancer.