The goal of this clinical trial is to test a way of delivering supportive care to adults 60 years and older who are starting venetoclax-based treatment for newly diagnosed acute myeloid leukemia (AML). Older adults with AML often have aging-related needs, such as problems with mobility, nutrition, mood, memory, or medications, that are not always addressed in a consistent way. In this study, a health questionnaire and short in-person checks (a geriatric assessment) are used to find these needs early, and matching supportive care orders are prepared in the electronic health record and sent to the treating doctor, who decides whether to place each one. This approach is called Active Default. The main questions the study aims to answer are:
* How often are the prepared supportive care orders signed by treating doctors (implementation fidelity)? * Can each step of the process, from completing the assessment to receiving supportive care services, be carried out as planned?
Participants will:
* Complete questionnaires and short in-person checks of walking, balance, strength, memory, mood, and medications at the start of treatment * Receive supportive care services (for example physical therapy, nutrition, or social work) if their doctor approves the prepared orders * Answer phone check-ins over 90 days and repeat two short checks at about two months * Be invited to one optional interview about their experience
Healthcare providers involved in participants' care will be invited to complete a one-time survey and an optional interview about the approach.
Age 60 years or older
Newly diagnosed acute myeloid leukemia (AML), including de novo, secondary, or therapy-related AML, per current World Health Organization (WHO) or International Consensus Classification (ICC) classification
Planned for first-line venetoclax-based lower-intensity therapy
English-speaking
Acute promyelocytic leukemia
Planned intensive induction or non-venetoclax-based therapy
Life expectancy under 14 days or hospice enrollment at screening
Single group
Active Default
BehavioralAn electronic health record-based order-queuing mechanism that delivers geriatric assessment-driven supportive care. A structured geriatric assessment is completed at the start of venetoclax-based therapy. Results crossing pre-specified thresholds trigger matched supportive care orders (for example physical therapy, nutrition, social work, pharmacy medication review, geriatrics, mental health, chaplaincy), which the study team prepares as proposed orders for the treating physician to approve or decline. The supportive care services themselves are standard of care; the intervention modifies only the order-entry workflow.
Proportion of eligible triggered supportive care orders signed by the treating physician within 7 days (implementation fidelity)
Measured as the number of eligible geriatric assessment-triggered supportive care orders signed by the treating physician within 7 days of order placement, divided by the total number of eligible triggered orders, using electronic health record order data. Eligible triggers are those not already engaged in the corresponding service or pre-declined by the patient at the pre-referral screen. Reported as a point estimate with 95% Clopper-Pearson confidence interval.
Proportion of signed supportive care orders with at least one completed service visit (service engagement)
Measured as the number of signed supportive care orders with at least one completed visit in the corresponding service within 90 days of Cycle 1 Day 1, divided by the total number of signed orders, using electronic health record data. Reported as a point estimate with 95% Clopper-Pearson confidence interval.
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This trial is not recruiting at the moment. You can still explore other options:
