Symptom screening with Targeted Early Palliative care (STEP) versus usual care for patients with advanced cancer: a mixed methods study

Purpose Although early palliative care is recommended, resource limitations prevent its routine implementation. We report on the preliminary findings of a mixed methods study involving a randomized controlled trial (RCT) of Symptom screening with Targeted Early Palliative care (STEP) and qualitative interviews. Methods Adults with advanced solid tumors and an oncologist-estimated prognosis of 6–36 months were randomized to STEP or symptom screening alone. STEP involved symptom screening at each outpatient oncology visit; moderate to severe scores triggered an email to a palliative care nurse, who offered referral to in-person outpatient palliative care. Patient-reported outcomes of quality of life (FACT-G7; primary outcome), depression (PHQ-9), symptom control (ESAS-r-CS), and satisfaction with care (FAMCARE P-16) were measured at baseline and 2, 4, and 6 months. Semi-structured interviews were conducted with a subset of participants. Results From Aug/2019 to Mar/2020 (trial halted due to COVID-19 pandemic), 69 participants were randomized to STEP (n = 33) or usual care (n = 36). At 6 months, 45% of STEP arm patients and 17% of screening alone participants had received palliative care (p = 0.009). Nonsignificant differences for all outcomes favored STEP: difference in change scores for FACT-G7 = 1.67 (95% CI: −1.43, 4.77); ESAS-r-CS = −5.51 (−14.29, 3.27); FAMCARE P-16 = 4.10 (−0.31, 8.51); PHQ-9 = −2.41 (−5.02, 0.20). Sixteen patients completed qualitative interviews, describing symptom screening as helpful to initiate communication; triggered referral as initially jarring but ultimately beneficial; and referral to palliative care as timely. Conclusion Despite lack of power for this halted trial, preliminary results favored STEP and qualitative results demonstrated acceptability. Findings will inform an RCT of combined in-person and virtual STEP..

Medienart:

E-Artikel

Erscheinungsjahr:

2023

Erschienen:

2023

Enthalten in:

Zur Gesamtaufnahme - volume:31

Enthalten in:

Supportive care in cancer - 31(2023), 7 vom: 21. Juni

Sprache:

Englisch

Beteiligte Personen:

Zimmermann, Camilla [VerfasserIn]
Pope, Ashley [VerfasserIn]
Hannon, Breffni [VerfasserIn]
Bedard, Philippe L. [VerfasserIn]
Rodin, Gary [VerfasserIn]
Dhani, Neesha [VerfasserIn]
Li, Madeline [VerfasserIn]
Herx, Leonie [VerfasserIn]
Krzyzanowska, Monika K. [VerfasserIn]
Howell, Doris [VerfasserIn]
Knox, Jennifer J. [VerfasserIn]
Leighl, Natasha B. [VerfasserIn]
Sridhar, Srikala [VerfasserIn]
Oza, Amit M. [VerfasserIn]
Lheureux, Stephanie [VerfasserIn]
Booth, Christopher M. [VerfasserIn]
Liu, Geoffrey [VerfasserIn]
Castro, Jacqueline Alcalde [VerfasserIn]
Swami, Nadia [VerfasserIn]
Sue-A-Quan, Rachel [VerfasserIn]
Rydall, Anne [VerfasserIn]
Le, Lisa W. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

Themen:

Cancer
Palliative care
Qualitative research
Quality of life
Randomized controlled trial
Symptom screening

RVK:

RVK Klassifikation

Anmerkungen:

© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s00520-023-07870-9

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2143999348

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