Discussion
cancer
CANCER
In this randomized clinical trial, a machine learning–based intervention increased SICs and decreased end-of-life systemic therapy among patients with cancer. Our findings suggest that machine learning–based interventions may lead to long-term reduction in low-value cancer care and offer several lessons.First, our intervention led to a sustained increase in SICs, and rates remained nearly 4 times above baseline after 6 months. A prior effort to improve serious illness communication has found inconsistent long-term results.Second, our subgroup analyses suggest that intervention effects were as strong or stronger among Medicaid beneficiaries, who have historically lower SIC rates.Third, our intervention decreased end-of-life systemic therapy. This impact stands in contrast to a prior trial,