Extra Layer Of Support (ELOS)

The investigators will conduct a prospective cohort study to investigate usability of implementing Ēlos across 50 advanced cancer patients within the Duke Cancer Institute and University of North Carolina - Chapel Hill Cancer Center. The investigators will obtain a Data Transfer Agreement prior to enrollment at the University of North Carolina. Usability testing evaluates a technology system's capacity for practical implementation in the field including logistical, social, financial, regulatory, and time considerations. The Usability test will also build foundational data needed to design a future, multi-site controlled trial evaluating the efficacy of Ēlos alongside exploring real-world implementation issues to address prior to undertaking the larger trial.

To conduct the study, the investigators will consecutively approach two populations: adult advanced cancer patients (defined as any Stage IV solid tumor malignancy, or Stage III pancreas or lung cancer) in the GI, GU, and Thoracic Cancer Clinics with a diagnosis made in the preceding eight weeks. The investigators will primarily evaluate usability through evaluating subject-reported perceived usefulness. .

The investigators will also measure change in patient self-efficacy and change knowledge of palliative care scores alongside obtaining baseline data on palliative care referral rates.

To evaluate perceived usefulness, the investigators will use the Perceived Usefulness Scale and Ease of Use subscales of the System Usability Scale, common tools used in health technology evaluations30 and a single item "I feel prepared for the palliative care visit".

Lastly, the investigators will measure subsequent referrals to palliative care, comparing the Ēlos cohort with a non-intervention cohort. the investigators will compare three cohorts: 1). Ēlos intervention cohort; 2). An age-, disease-, and stage-matched cohort of usual care patients during the same time period as the intervention; and 3). A similarly-matched cohort who received usual oncology care six months prior to the study. The latter control cohort evaluates palliative care referral practices prior to any intervention taking place to reduce contamination. The investigators will use these preliminary data on referral rates to determine the effect sizes needed to calculate the sample sizes for an Alliance CCDR protocol for a NCORP trial.