An interventional study of Best Practice and Internet-Based Intervention in Hematopoietic and Lymphoid System Neoplasm, Locally Advanced Malignant Solid Neoplasm and Metastatic Malignant Solid Neoplasm, sponsored by Fred Hutchinson Cancer Center. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-10-02.
Sponsored by Fred Hutchinson Cancer Center · Not applicable, Interventional, and Supportive care
This clinical trial examines a web-based tool, in partnership with Peacefully, Inc, designed to improve end-of-life planning among patients with advanced cancers. This program helps users prepare comprehensively for end-of-life (e.g., medical wishes, legal estate planning, financial planning and transfer of accounts, legacy building, and emotional support). It is expected that this web-based end-of-life planning program may reduce distress and improve end-of-life preparation among advanced cancer patients.
OUTLINE:
Patients are randomized to 1 of 2 groups and their engagement in end-of-life planning is assessed at baseline and four weeks post-randomization.
Group I (intervention): Patients receive Peacefully's web-based tool to help with end-of-life planning on day 7.
Group II (control): Patients receive standard of care.
After completion of study, patients are followed up at 4, 12, and 24 weeks post-randomization.
3,517 studies on the registry are indexed under Neoplasm Metastasis; 885 are open to participants now.
This study's enrollment of 100 is above the median of 54 across 2,767 interventional studies indexed under Neoplasm Metastasis.
Browse Neoplasm Metastasis studies →Fred Hutchinson Cancer Center is the lead sponsor of 537 studies on the registry; 79 are open to participants now.
Of its 57 completed or terminated interventional studies of FDA-regulated products, 45 (79%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Patients receive Peacefully's web-based tool to help with end-of-life planning on day 7.
Other: Internet-Based Intervention · Other: Questionnaire Administration
Patients receive standard care.
Other: Best Practice · Other: Questionnaire Administration
Receive standard of care
Also known as: standard of care, standard therapy
Receive Peacefully's end-of-life planning program
Ancillary studies
Change in Comprehensive End-of-life Planning, From Baseline to 4 Weeks Post-randomization
Will be measured using a 14-item checklist of all completed tasks from the checklists/tasks on the website (eg, gather important documents, create a will). Scores are computed by summing together the total number of planning items completed. Scores can range from 0 to 14, with higher scores indicating increases in completion of end-of-life planning tasks. Change scores can range from -14 to +14.
Time frame: Baseline and Week 4 post-randomization
Change in Comprehensive End-of-life Planning, From Baseline to 12 Weeks Post-randomization
Will be measured using a 14-item checklist of all completed tasks from the checklists/tasks on the website (eg, gather important documents, create a will). Scores are computed by summing together the total number of planning items completed. Scores can range from 0 to 14, with higher scores indicating increases in completion of end-of-life planning tasks. Change scores can range from -14 to +14.
Time frame: Baseline and Week 12 post-randomization
Change in Comprehensive End-of-life Planning, From Baseline to 24 Weeks Post-randomization
Will be measured using a 14-item checklist of all completed tasks from the checklists/tasks on the website (eg, gather important documents, create a will). Scores are computed by summing together the total number of planning items completed. Scores can range from 0 to 14, with higher scores indicating increases in completion of end-of-life planning tasks. Change scores can range from -14 to +14.
Time frame: Baseline and Week 24 post-randomization
Change in Patients' Engagement in Advance Care Planning, as Measured by the Decision Maker Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 4 Weeks Post-randomization
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Decision Maker (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around advance care planning (e.g., "Have you already decided who you want your medical decision maker to be?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning. Change scores can range from -4 to +4.
Time frame: Baseline and Week 4 post-randomization
Change in Patients' Engagement in Advance Care Planning, as Measured by the Decision Maker Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 12 Weeks Post-randomization
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Decision Maker (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around advance care planning (e.g., "Have you already decided who you want your medical decision maker to be?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning. Change scores can range from -4 to +4.
Time frame: Baseline and Week 12 post-randomization
Change in Patients' Engagement in Advance Care Planning, as Measured by the Decision Maker Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 24 Weeks Post-randomization
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Decision Maker (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around advance care planning (e.g., "Have you already decided who you want your medical decision maker to be?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning. Change scores can range from -4 to +4.
Time frame: Baseline and Week 24 post-randomization
Change in Patients' Engagement in Advance Care Planning, as Measured by the Quality of Life Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 4 Weeks Post-randomization
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Quality of Life (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around quality of life in advance care planning (e.g., "Have you already decided whether or not certain health situations would make your life not worth living?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning as it pertains to quality of life. Change scores can range from -4 to +4.
Time frame: Baseline and Week 4 post-randomization
Change in Patients' Engagement in Advance Care Planning, as Measured by the Quality of Life Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 12 Weeks Post-randomization
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Quality of Life (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around quality of life in advance care planning (e.g., "Have you already decided whether or not certain health situations would make your life not worth living?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning as it pertains to quality of life. Change scores can range from -4 to +4.
Time frame: Baseline and Week 12 post-randomization
Change in Patients' Engagement in Advance Care Planning, as Measured by the Quality of Life Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 24 Weeks Post-randomization
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Quality of Life (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around quality of life in advance care planning (e.g., "Have you already decided whether or not certain health situations would make your life not worth living?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning as it pertains to quality of life. Change scores can range from -4 to +4.
Time frame: Baseline and Week 24 post-randomization
Change in Advance Care Planning Engagement: Conversations Discussing EoL Care, Living Will, HCP, and DNR Orders With Family Members/Loved Ones and Doctors, From Baseline to 4 Weeks Post-randomization
Engagement in ACP with family members/loved ones and doctors will be assessed in patients. This outcome will consist of documentation of ACP conversations using the investigators' previously utilized 8-item measure of discussing EoL care, living will, HCP, and DNR orders with family (4 items) and doctors (4 items). Scores for the subscale are computed by summing together the total number of ACP topic discussed with the patient's family members/loved ones and doctors. Scores can range from 0 to 8, with higher scores indicating increases in engagement in ACP conversations with family members/loved ones and doctors. Change scores can range from -8 to +8.
Time frame: Baseline and Week 4 post-randomization
Change in Advance Care Planning Engagement: Conversations Discussing EoL Care, Living Will, HCP, and DNR Orders With Family Members/Loved Ones and Doctors, From Baseline to 12 Weeks Post-randomization
Engagement in ACP with family members/loved ones and doctors will be assessed in patients. This outcome will consist of documentation of ACP conversations using the investigators' previously utilized 8-item measure of discussing EoL care, living will, HCP, and DNR orders with family (4 items) and doctors (4 items). Scores for the subscale are computed by summing together the total number of ACP topic discussed with the patient's family members/loved ones and doctors. Scores can range from 0 to 8, with higher scores indicating increases in engagement in ACP conversations with family members/loved ones and doctors. Change scores can range from -8 to +8.
Time frame: Baseline and Week 12 post-randomization
Change in Advance Care Planning Engagement: Conversations Discussing EoL Care, Living Will, HCP, and DNR Orders With Family Members/Loved Ones and Doctors, From Baseline to 24 Weeks Post-randomization
Engagement in ACP with family members/loved ones and doctors will be assessed in patients. This outcome will consist of documentation of ACP conversations using the investigators' previously utilized 8-item measure of discussing EoL care, living will, HCP, and DNR orders with family (4 items) and doctors (4 items). Scores for the subscale are computed by summing together the total number of ACP topic discussed with the patient's family members/loved ones and doctors. Scores can range from 0 to 8, with higher scores indicating increases in engagement in ACP conversations with family members/loved ones and doctors. Change scores can range from -8 to +8.
Time frame: Baseline and Week 24 post-randomization
Change in Advance Care Planning Engagement: Completion of Advance Directives, From Baseline to 4 Weeks Post-randomization
Completion of advance directives will be assessed by asking patients whether they completed a do-not-resuscitate order, a living will, and/or identified a health care proxy; data will be verified through the patient's electronic health record. Change in these numbers will be assessed at baseline and post-intervention. Scores are computed by summing together the total number of advance directives completed. Scores can range from 0 to 3, with higher scores indicating increases in completion of advance directives. Change scores can range from -3 to +3.
Time frame: Baseline and Week 4 post-randomization
Change in Advance Care Planning Engagement: Completion of Advance Directives, From Baseline to 12 Weeks Post-randomization
Completion of advance directives will be assessed by asking patients whether they completed a do-not-resuscitate order, a living will, and/or identified a health care proxy; data will be verified through the patient's electronic health record. Change in these numbers will be assessed at baseline and post-intervention. Scores are computed by summing together the total number of advance directives completed. Scores can range from 0 to 3, with higher scores indicating increases in completion of advance directives. Change scores can range from -3 to +3.
Time frame: Baseline and Week 12 post-randomization
Change in Advance Care Planning Engagement: Completion of Advance Directives, From Baseline to 24 Weeks Post-randomization
Completion of advance directives will be assessed by asking patients whether they completed a do-not-resuscitate order, a living will, and/or identified a health care proxy; data will be verified through the patient's electronic health record. Change in these numbers will be assessed at baseline and post-intervention. Scores are computed by summing together the total number of advance directives completed. Scores can range from 0 to 3, with higher scores indicating increases in completion of advance directives. Change scores can range from -3 to +3.
Time frame: Baseline and Week 24 post-randomization
Change in Anxiety, as Measured by the Anxiety Subscale of the Hospital Anxiety and Depression Scale (HADS-A), From Baseline to 4 Weeks Post-randomization
Anxiety will be measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), a valid and reliable 7-item, Likert-type self-report measure of mood disturbance commonly used with cancer patients. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a HADS-A total score. Total scores can range from 0 to 21, with higher numbers indicating higher levels of anxiety. Change in anxiety will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -21 to +21.
Time frame: Baseline and Week 4 post-randomization
Change in Anxiety, as Measured by the Anxiety Subscale of the Hospital Anxiety and Depression Scale (HADS-A), From Baseline to 12 Weeks Post-randomization
Anxiety will be measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), a valid and reliable 7-item, Likert-type self-report measure of mood disturbance commonly used with cancer patients. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a HADS-A total score. Total scores can range from 0 to 21, with higher numbers indicating higher levels of anxiety. Change in anxiety will be assessed at baseline and post-randomization. Change scores can range from -21 to +21.
Time frame: Baseline and Week 12 post-randomization
Change in Anxiety, as Measured by the Anxiety Subscale of the Hospital Anxiety and Depression Scale (HADS-A), From Baseline to 24 Weeks Post-randomization
Anxiety will be measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), a valid and reliable 7-item, Likert-type self-report measure of mood disturbance commonly used with cancer patients. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a HADS-A total score. Total scores can range from 0 to 21, with higher numbers indicating higher levels of anxiety. Change in anxiety will be assessed at baseline and post-randomization. Change scores can range from -21 to +21.
Time frame: Baseline and Week 24 post-randomization
Change in Psychological Distress, as Measured by the Center for Epidemiological Studies Depression Scale (CESD), From Baseline to 4 Weeks Post-randomization
Psychological Distress will be measured using the Center for Epidemiological Studies Depression Scale (CESD), a valid and reliable 20-item, Likert-type self-report measure of frequency and severity of depressive symptoms over the previous week. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a total score. Total scores can range from 0 to 60, with higher numbers indicating higher levels of psychological distress. Change in psychological distress will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -60 to +60.
Time frame: Baseline and Week 4 post-randomization
Change in Psychological Distress, as Measured by the Center for Epidemiological Studies Depression Scale (CESD), From Baseline to 12 Weeks Post-randomization
Psychological Distress will be measured using the Center for Epidemiological Studies Depression Scale (CESD), a valid and reliable 20-item, Likert-type self-report measure of frequency and severity of depressive symptoms over the previous week. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a total score. Total scores can range from 0 to 60, with higher numbers indicating higher levels of psychological distress. Change in psychological distress will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -60 to +60.
Time frame: Baseline and week 12 post-randomization
Change in Psychological Distress, as Measured by the Center for Epidemiological Studies Depression Scale (CESD), From Baseline to 24 Weeks Post-randomization
Psychological Distress will be measured using the Center for Epidemiological Studies Depression Scale (CESD), a valid and reliable 20-item, Likert-type self-report measure of frequency and severity of depressive symptoms over the previous week. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a total score. Total scores can range from 0 to 60, with higher numbers indicating higher levels of psychological distress. Change in psychological distress will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -60 to +60.
Time frame: Baseline and Week 24 post-randomization
Change in Emotional Social Well-being, as Measured by the Functional Assessment of Cancer Therapy-General (FACT-G) Scale, From Baseline to 4 Weeks Post-randomization
Emotional and social well-being will be measured using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale. The FACT-G scale contains 27 items that ask patients to rate the degree to which they agree to statements about their well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating better well-being. Total scores can range from 0-108. Change in emotional and social well-being will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -108 to +108.
Time frame: Baseline and Week 4 post-randomization
Change in Emotional Social Well-being, as Measured by the Functional Assessment of Cancer Therapy-General (FACT-G) Scale, From Baseline to 12 Weeks Post-randomization
Emotional and social well-being will be measured using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale. The FACT-G scale contains 27 items that ask patients to rate the degree to which they agree to statements about their well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating better well-being. Total scores can range from 0-108. Change in emotional and social well-being will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -108 to +108.
Time frame: Baseline and Week 12 post-randomization
Change in Emotional Social Well-being, as Measured by the Functional Assessment of Cancer Therapy-General (FACT-G) Scale, From Baseline to 24 Weeks Post-randomization
Emotional and social well-being will be measured using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale. The FACT-G scale contains 27 items that ask patients to rate the degree to which they agree to statements about their well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating better well-being. Total scores can range from 0-108. Change in emotional and social well-being will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -108 to +108.
Time frame: Baseline and Week 24 post-randomization
Change in Spiritual Well-being, as Measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), From Baseline to 4 Weeks Post-randomization
Spiritual well-being will be measured using the validated, 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The FACIT-Sp asks patients to indicate the degree to which they agree with statements about their spiritual well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating greater spiritual well-being. Total scores range from 0 to 48. Change in spiritual well-being will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -48 to +48.
Time frame: Baseline and Week 4 post-randomization
Change in Spiritual Well-being, as Measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, From Baseline to 12 Weeks Post-randomization
Spiritual well-being will be measured using the validated, 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The FACIT-Sp asks patients to indicate the degree to which they agree with statements about their spiritual well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating greater spiritual well-being. Total scores range from 0 to 48. Change in spiritual well-being will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -48 to +48.
Time frame: Baseline and Week 12 post-randomization
Change in Spiritual Well-being, as Measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, From Baseline to 24 Weeks Post-randomization
Spiritual well-being will be measured using the validated, 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The FACIT-Sp asks patients to indicate the degree to which they agree with statements about their spiritual well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating greater spiritual well-being. Total scores range from 0 to 48. Change in spiritual well-being will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -48 to +48.
Time frame: Baseline and Week 24 post-randomization
Change in Financial Well-being, as Measured by the InCharge Financial Distress/Financial Well-Being Scale, From Baseline to 4 Weeks Post-randomization
Financial well-being will be measured using the validated, 8-item InCharge Financial Distress/Financial Well-Being scale. This scale asks patients to rate their financial wellness (stress, satisfaction, etc.) on a 10-point Likert scale that varies for each response but for which 1 indicates the lowest financial well-being and 10 indicates the highest (e.g., 1=overwhelming stress to 10 = not stress at all; 1 = worry all the time, 10 - never worry). Total scores range from 8 to 80, with higher scores indicating greater financial well-being. Change in financial well-being will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -72 to +72.
Time frame: Baseline and Week 4 post-randomization
Change in Financial Well-being, as Measured by the InCharge Financial Distress/Financial Well-Being Scale, From Baseline to 12 Weeks Post-randomization
Financial well-being will be measured using the validated, 8-item InCharge Financial Distress/Financial Well-Being scale. This scale asks patients to rate their financial wellness (stress, satisfaction, etc.) on a 10-point Likert scale that varies for each response but for which 1 indicates the lowest financial well-being and 10 indicates the highest (e.g., 1=overwhelming stress to 10 = not stress at all; 1 = worry all the time, 10 - never worry). Total scores range from 8 to 80, with higher scores indicating greater financial well-being. Change in financial well-being will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -72 to +72.
Time frame: Baseline and Week 12 post-randomization
Change in Financial Well-being, as Measured by the InCharge Financial Distress/Financial Well-Being Scale, From Baseline to 24 Weeks Post-randomization
Financial well-being will be measured using the validated, 8-item InCharge Financial Distress/Financial Well-Being scale. This scale asks patients to rate their financial wellness (stress, satisfaction, etc.) on a 10-point Likert scale that varies for each response but for which 1 indicates the lowest financial well-being and 10 indicates the highest (e.g., 1=overwhelming stress to 10 = not stress at all; 1 = worry all the time, 10 - never worry). Total scores range from 8 to 80, with higher scores indicating greater financial well-being. Change in financial well-being will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -72 to +72.
Time frame: Baseline and Week 24 post-randomization
| Milestone | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Started | 36 | 35 |
| Per protocol population week 4 | 23 | 24 |
| Per protocol population week 12 | 6 | 6 |
| Per protocol population week 24 | 2 | 2 |
| Completed | 2 | 2 |
| Not completed | 34 | 33 |
| Withdrew: Death | 6 | 4 |
| Withdrew: Lost to follow-up | 9 | 10 |
| Withdrew: Withdrawal by subject | 11 | 7 |
| Withdrew: No longer physically capable | 3 | 7 |
| Withdrew: No longer cognitively capable | 5 | 5 |
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Decision Maker (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around advance care planning (e.g., "Have you already decided who you want your medical decision maker to be?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning. Change scores can range from -4 to +4.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Patients' Engagement in Advance Care Planning, as Measured by the Decision Maker Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 4 Weeks Post-randomization | 0.26 ± 0.86 | 0.13 ± 0.80 |
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Decision Maker (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around advance care planning (e.g., "Have you already decided who you want your medical decision maker to be?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning. Change scores can range from -4 to +4.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Patients' Engagement in Advance Care Planning, as Measured by the Decision Maker Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 12 Weeks Post-randomization | 0.17 ± 0.41 | 0.50 ± 1.05 |
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Decision Maker (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around advance care planning (e.g., "Have you already decided who you want your medical decision maker to be?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning. Change scores can range from -4 to +4.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Patients' Engagement in Advance Care Planning, as Measured by the Decision Maker Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 24 Weeks Post-randomization | 0.00 ± 0.00 | 0.50 ± 0.71 |
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Quality of Life (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around quality of life in advance care planning (e.g., "Have you already decided whether or not certain health situations would make your life not worth living?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning as it pertains to quality of life. Change scores can range from -4 to +4.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Patients' Engagement in Advance Care Planning, as Measured by the Quality of Life Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 4 Weeks Post-randomization | 0.26 ± 1.18 | 0.75 ± 1.07 |
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Quality of Life (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around quality of life in advance care planning (e.g., "Have you already decided whether or not certain health situations would make your life not worth living?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning as it pertains to quality of life. Change scores can range from -4 to +4.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Patients' Engagement in Advance Care Planning, as Measured by the Quality of Life Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 12 Weeks Post-randomization | -0.17 ± 0.98 | 0.67 ± 2.50 |
Change in patient engagement in advance care planning will be assessed in patients using the reliable and valid Quality of Life (four items) subscale of the Advance Care Planning Engagement Survey: Action Measures. Response options include: yes=1, no=0. Questions include those asking about whether patients have engaged in a decision around quality of life in advance care planning (e.g., "Have you already decided whether or not certain health situations would make your life not worth living?") Individual scores can range from 0 to 4, with higher scores indicating that more decisions have been made around advance care planning as it pertains to quality of life. Change scores can range from -4 to +4.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Patients' Engagement in Advance Care Planning, as Measured by the Quality of Life Subscale of the Advance Care Planning Engagement Survey: Action Measures, From Baseline to 24 Weeks Post-randomization | 0.50 ± 0.71 | 1.00 ± 1.41 |
Engagement in ACP with family members/loved ones and doctors will be assessed in patients. This outcome will consist of documentation of ACP conversations using the investigators' previously utilized 8-item measure of discussing EoL care, living will, HCP, and DNR orders with family (4 items) and doctors (4 items). Scores for the subscale are computed by summing together the total number of ACP topic discussed with the patient's family members/loved ones and doctors. Scores can range from 0 to 8, with higher scores indicating increases in engagement in ACP conversations with family members/loved ones and doctors. Change scores can range from -8 to +8.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Advance Care Planning Engagement: Conversations Discussing EoL Care, Living Will, HCP, and DNR Orders With Family Members/Loved Ones and Doctors, From Baseline to 4 Weeks Post-randomization | 1.22 ± 1.50 | 0.29 ± 1.60 |
Engagement in ACP with family members/loved ones and doctors will be assessed in patients. This outcome will consist of documentation of ACP conversations using the investigators' previously utilized 8-item measure of discussing EoL care, living will, HCP, and DNR orders with family (4 items) and doctors (4 items). Scores for the subscale are computed by summing together the total number of ACP topic discussed with the patient's family members/loved ones and doctors. Scores can range from 0 to 8, with higher scores indicating increases in engagement in ACP conversations with family members/loved ones and doctors. Change scores can range from -8 to +8.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Advance Care Planning Engagement: Conversations Discussing EoL Care, Living Will, HCP, and DNR Orders With Family Members/Loved Ones and Doctors, From Baseline to 12 Weeks Post-randomization | 0.50 ± 1.38 | 1.83 ± 1.72 |
Engagement in ACP with family members/loved ones and doctors will be assessed in patients. This outcome will consist of documentation of ACP conversations using the investigators' previously utilized 8-item measure of discussing EoL care, living will, HCP, and DNR orders with family (4 items) and doctors (4 items). Scores for the subscale are computed by summing together the total number of ACP topic discussed with the patient's family members/loved ones and doctors. Scores can range from 0 to 8, with higher scores indicating increases in engagement in ACP conversations with family members/loved ones and doctors. Change scores can range from -8 to +8.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Advance Care Planning Engagement: Conversations Discussing EoL Care, Living Will, HCP, and DNR Orders With Family Members/Loved Ones and Doctors, From Baseline to 24 Weeks Post-randomization | 1.00 ± 1.41 | 0.50 ± 0.71 |
Completion of advance directives will be assessed by asking patients whether they completed a do-not-resuscitate order, a living will, and/or identified a health care proxy; data will be verified through the patient's electronic health record. Change in these numbers will be assessed at baseline and post-intervention. Scores are computed by summing together the total number of advance directives completed. Scores can range from 0 to 3, with higher scores indicating increases in completion of advance directives. Change scores can range from -3 to +3.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Advance Care Planning Engagement: Completion of Advance Directives, From Baseline to 4 Weeks Post-randomization | 0.09 ± 0.73 | 0.29 ± 0.95 |
Completion of advance directives will be assessed by asking patients whether they completed a do-not-resuscitate order, a living will, and/or identified a health care proxy; data will be verified through the patient's electronic health record. Change in these numbers will be assessed at baseline and post-intervention. Scores are computed by summing together the total number of advance directives completed. Scores can range from 0 to 3, with higher scores indicating increases in completion of advance directives. Change scores can range from -3 to +3.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Advance Care Planning Engagement: Completion of Advance Directives, From Baseline to 12 Weeks Post-randomization | -0.33 ± 0.52 | 0.83 ± 0.98 |
Completion of advance directives will be assessed by asking patients whether they completed a do-not-resuscitate order, a living will, and/or identified a health care proxy; data will be verified through the patient's electronic health record. Change in these numbers will be assessed at baseline and post-intervention. Scores are computed by summing together the total number of advance directives completed. Scores can range from 0 to 3, with higher scores indicating increases in completion of advance directives. Change scores can range from -3 to +3.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Advance Care Planning Engagement: Completion of Advance Directives, From Baseline to 24 Weeks Post-randomization | -0.5 ± 0.71 | -0.5 ± 2.12 |
Will be measured using a 14-item checklist of all completed tasks from the checklists/tasks on the website (eg, gather important documents, create a will). Scores are computed by summing together the total number of planning items completed. Scores can range from 0 to 14, with higher scores indicating increases in completion of end-of-life planning tasks. Change scores can range from -14 to +14.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Comprehensive End-of-life Planning, From Baseline to 4 Weeks Post-randomization | 1.57 ± 2.17 | 0.04 ± 1.76 |
Will be measured using a 14-item checklist of all completed tasks from the checklists/tasks on the website (eg, gather important documents, create a will). Scores are computed by summing together the total number of planning items completed. Scores can range from 0 to 14, with higher scores indicating increases in completion of end-of-life planning tasks. Change scores can range from -14 to +14.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Comprehensive End-of-life Planning, From Baseline to 12 Weeks Post-randomization | 1.17 ± 2.32 | 1.00 ± 1.41 |
Will be measured using a 14-item checklist of all completed tasks from the checklists/tasks on the website (eg, gather important documents, create a will). Scores are computed by summing together the total number of planning items completed. Scores can range from 0 to 14, with higher scores indicating increases in completion of end-of-life planning tasks. Change scores can range from -14 to +14.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Comprehensive End-of-life Planning, From Baseline to 24 Weeks Post-randomization | 0.00 ± 0.00 | 1.50 ± 2.12 |
Anxiety will be measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), a valid and reliable 7-item, Likert-type self-report measure of mood disturbance commonly used with cancer patients. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a HADS-A total score. Total scores can range from 0 to 21, with higher numbers indicating higher levels of anxiety. Change in anxiety will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -21 to +21.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Anxiety, as Measured by the Anxiety Subscale of the Hospital Anxiety and Depression Scale (HADS-A), From Baseline to 4 Weeks Post-randomization | -1.04 ± 1.64 | -0.34 ± 2.30 |
Anxiety will be measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), a valid and reliable 7-item, Likert-type self-report measure of mood disturbance commonly used with cancer patients. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a HADS-A total score. Total scores can range from 0 to 21, with higher numbers indicating higher levels of anxiety. Change in anxiety will be assessed at baseline and post-randomization. Change scores can range from -21 to +21.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Anxiety, as Measured by the Anxiety Subscale of the Hospital Anxiety and Depression Scale (HADS-A), From Baseline to 12 Weeks Post-randomization | 0.00 ± 1.79 | -0.67 ± 3.33 |
Anxiety will be measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), a valid and reliable 7-item, Likert-type self-report measure of mood disturbance commonly used with cancer patients. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a HADS-A total score. Total scores can range from 0 to 21, with higher numbers indicating higher levels of anxiety. Change in anxiety will be assessed at baseline and post-randomization. Change scores can range from -21 to +21.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Anxiety, as Measured by the Anxiety Subscale of the Hospital Anxiety and Depression Scale (HADS-A), From Baseline to 24 Weeks Post-randomization | -0.50 ± 0.71 | -1.00 ± 1.41 |
Psychological Distress will be measured using the Center for Epidemiological Studies Depression Scale (CESD), a valid and reliable 20-item, Likert-type self-report measure of frequency and severity of depressive symptoms over the previous week. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a total score. Total scores can range from 0 to 60, with higher numbers indicating higher levels of psychological distress. Change in psychological distress will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -60 to +60.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Psychological Distress, as Measured by the Center for Epidemiological Studies Depression Scale (CESD), From Baseline to 4 Weeks Post-randomization | -1.87 ± 6.61 | 0.46 ± 5.90 |
Psychological Distress will be measured using the Center for Epidemiological Studies Depression Scale (CESD), a valid and reliable 20-item, Likert-type self-report measure of frequency and severity of depressive symptoms over the previous week. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a total score. Total scores can range from 0 to 60, with higher numbers indicating higher levels of psychological distress. Change in psychological distress will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -60 to +60.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Psychological Distress, as Measured by the Center for Epidemiological Studies Depression Scale (CESD), From Baseline to 12 Weeks Post-randomization | 1.00 ± 6.75 | 2.33 ± 7.12 |
Psychological Distress will be measured using the Center for Epidemiological Studies Depression Scale (CESD), a valid and reliable 20-item, Likert-type self-report measure of frequency and severity of depressive symptoms over the previous week. Each item on this scale is rated on a 4-point scale (0 to 3), and all items are summed to create a total score. Total scores can range from 0 to 60, with higher numbers indicating higher levels of psychological distress. Change in psychological distress will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -60 to +60.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Psychological Distress, as Measured by the Center for Epidemiological Studies Depression Scale (CESD), From Baseline to 24 Weeks Post-randomization | -3.50 ± 3.54 | 1.00 ± 1.41 |
Emotional and social well-being will be measured using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale. The FACT-G scale contains 27 items that ask patients to rate the degree to which they agree to statements about their well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating better well-being. Total scores can range from 0-108. Change in emotional and social well-being will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -108 to +108.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Emotional Social Well-being, as Measured by the Functional Assessment of Cancer Therapy-General (FACT-G) Scale, From Baseline to 4 Weeks Post-randomization | 2.57 ± 5.30 | -1.46 ± 6.92 |
Emotional and social well-being will be measured using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale. The FACT-G scale contains 27 items that ask patients to rate the degree to which they agree to statements about their well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating better well-being. Total scores can range from 0-108. Change in emotional and social well-being will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -108 to +108.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Emotional Social Well-being, as Measured by the Functional Assessment of Cancer Therapy-General (FACT-G) Scale, From Baseline to 12 Weeks Post-randomization | 0.33 ± 2.94 | -6.33 ± 8.41 |
Emotional and social well-being will be measured using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) scale. The FACT-G scale contains 27 items that ask patients to rate the degree to which they agree to statements about their well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating better well-being. Total scores can range from 0-108. Change in emotional and social well-being will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -108 to +108.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Emotional Social Well-being, as Measured by the Functional Assessment of Cancer Therapy-General (FACT-G) Scale, From Baseline to 24 Weeks Post-randomization | 1.50 ± 3.54 | 3.00 ± 2.83 |
Spiritual well-being will be measured using the validated, 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The FACIT-Sp asks patients to indicate the degree to which they agree with statements about their spiritual well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating greater spiritual well-being. Total scores range from 0 to 48. Change in spiritual well-being will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -48 to +48.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Spiritual Well-being, as Measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), From Baseline to 4 Weeks Post-randomization | 1.87 ± 3.14 | -0.88 ± 4.92 |
Spiritual well-being will be measured using the validated, 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The FACIT-Sp asks patients to indicate the degree to which they agree with statements about their spiritual well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating greater spiritual well-being. Total scores range from 0 to 48. Change in spiritual well-being will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -48 to +48.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Spiritual Well-being, as Measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, From Baseline to 12 Weeks Post-randomization | 1.00 ± 4.24 | 1.83 ± 3.92 |
Spiritual well-being will be measured using the validated, 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The FACIT-Sp asks patients to indicate the degree to which they agree with statements about their spiritual well-being. Each item on this scale is rated on a 5-point Likert scale (0 = not at all, 4 = very much), with higher scores indicating greater spiritual well-being. Total scores range from 0 to 48. Change in spiritual well-being will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -48 to +48.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Spiritual Well-being, as Measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, From Baseline to 24 Weeks Post-randomization | 1.00 ± 5.66 | 4.00 ± 2.83 |
Financial well-being will be measured using the validated, 8-item InCharge Financial Distress/Financial Well-Being scale. This scale asks patients to rate their financial wellness (stress, satisfaction, etc.) on a 10-point Likert scale that varies for each response but for which 1 indicates the lowest financial well-being and 10 indicates the highest (e.g., 1=overwhelming stress to 10 = not stress at all; 1 = worry all the time, 10 - never worry). Total scores range from 8 to 80, with higher scores indicating greater financial well-being. Change in financial well-being will be assessed at baseline and 4 weeks post-randomization. Change scores can range from -72 to +72.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Financial Well-being, as Measured by the InCharge Financial Distress/Financial Well-Being Scale, From Baseline to 4 Weeks Post-randomization | 2.09 ± 4.89 | -1.96 ± 7.43 |
Financial well-being will be measured using the validated, 8-item InCharge Financial Distress/Financial Well-Being scale. This scale asks patients to rate their financial wellness (stress, satisfaction, etc.) on a 10-point Likert scale that varies for each response but for which 1 indicates the lowest financial well-being and 10 indicates the highest (e.g., 1=overwhelming stress to 10 = not stress at all; 1 = worry all the time, 10 - never worry). Total scores range from 8 to 80, with higher scores indicating greater financial well-being. Change in financial well-being will be assessed at baseline and 12 weeks post-randomization. Change scores can range from -72 to +72.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Financial Well-being, as Measured by the InCharge Financial Distress/Financial Well-Being Scale, From Baseline to 12 Weeks Post-randomization | 1.33 ± 8.43 | 3.33 ± 4.59 |
Financial well-being will be measured using the validated, 8-item InCharge Financial Distress/Financial Well-Being scale. This scale asks patients to rate their financial wellness (stress, satisfaction, etc.) on a 10-point Likert scale that varies for each response but for which 1 indicates the lowest financial well-being and 10 indicates the highest (e.g., 1=overwhelming stress to 10 = not stress at all; 1 = worry all the time, 10 - never worry). Total scores range from 8 to 80, with higher scores indicating greater financial well-being. Change in financial well-being will be assessed at baseline and 24 weeks post-randomization. Change scores can range from -72 to +72.
| Score on a scale | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Change in Financial Well-being, as Measured by the InCharge Financial Distress/Financial Well-Being Scale, From Baseline to 24 Weeks Post-randomization | -2.50 ± 0.71 | 0.50 ± 0.71 |
Collected over From enrollment until end of follow-up (up to 24 weeks). Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Group I (Peacefully's) | 6/36 (16.7%) | 0/36 (0%) | 3/36 (8.3%) |
| Group II (Standard of Care) | 4/35 (11.4%) | 0/35 (0%) | 0/35 (0%) |
| Event | Group I (Peacefully's) | Group II (Standard of Care) |
|---|---|---|
| Patient-reported psychological distressGeneral disorders | 3/36 | — |
| Age, Continuous(years) | Group I (Peacefully's) | Group II (Standard of Care) | Total |
|---|---|---|---|
| Mean | 56.7 ± 13.39 | 57.9 ± 10.77 | 57.3 ± 12.10 |
| Sex/Gender, Customized(Participants) | Group I (Peacefully's) | Group II (Standard of Care) | Total |
|---|---|---|---|
| Male | 7 | 10 | 17 |
| Female | 28 | 25 | 53 |
| Non-binary | 1 | 0 | 1 |
| Race (NIH/OMB)(Participants) | Group I (Peacefully's) | Group II (Standard of Care) | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 1 | 2 | 3 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 32 | 31 | 63 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 3 | 2 | 5 |
| Ethnicity (NIH/OMB)(Participants) | Group I (Peacefully's) | Group II (Standard of Care) | Total |
|---|---|---|---|
| Hispanic or Latino | 2 | 0 | 2 |
| Not Hispanic or Latino | 33 | 34 | 67 |
| Unknown or Not Reported | 1 | 1 | 2 |
| Comprehensive End-of-Life Planning(score on a scale) | Group I (Peacefully's) | Group II (Standard of Care) | Total |
|---|---|---|---|
| Mean | 7.11 ± 3.50 | 7.29 ± 3.78 | 7.20 ± 3.61 |
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Fred Hutchinson Cancer Center