The impact of a geriatric assessment-guided management intervention (GAIN-S) on prognostic awareness: A randomized controlled trial.

Abstract

Geriatric assessment (GA)-guided supportive care (GAIN-S) may improve decision-making in older adults with cancer, but its effects on prognostic awareness remain unclear. The authors evaluated whether GAIN-S enhances prognostic awareness among older adults with metastatic cancer in Brazil. This randomized controlled trial was conducted in Brazil (June 2022-July 2023). Adults ≥65 years old with metastatic cancer were randomized 1:1 to GAIN-S (n = 39) or usual care (UC; n = 38). GAIN-S included multidisciplinary GA review, individualized care planning, and targeted referrals. UC consisted of standard care without GA-guided interventions. Prognostic awareness was assessed using the Prognostic Awareness Impact Questionnaire, covering emotional (10 items; range, 0-30), adaptive (12 items; range, 0-36), and cognitive (2 categorical items) domains. Group differences were analyzed using t-tests; item-level analyses used Mann-Whitney U, McNemar's, or χ² tests. Seventy-seven participants were enrolled (mean age, 74.5; 56% female). Common cancers included genitourinary (29.9%), breast (24.7%), and gastrointestinal (22.1%). GAIN-S led to greater improvements in emotional (mean difference = 1.14, standard error [SE] = 0.35, p = .002) and adaptive (mean difference = 0.82, SE = 0.30, p = .008) domains compared to UC. No differences were observed in the cognitive domain. Most participants reported their oncologist had not clearly stated whether their cancer was curable (74% GAIN-S vs. 57% UC). GAIN-S participants more often reported improved coping with prognostic uncertainty, better emotional acceptance, and reduced distress (all p < .05). GAIN-S improved emotional and adaptive domains of prognostic awareness. These novel findings underscore the value of the GAIN-S intervention for older adults. Studies are needed to explore longer-term effects on decision-making, communication, and quality of life.