Context. Low utilization of palliative care services warrant testing of new solutions to educate and engage patients around the benefits of palliative care.Objectives. We sought out to develop and test a novel, mobile health solution to prepare patients for an upcoming outpatient palliative care appointment.Methods. After developing a web-based tool called PCforMe (Palliative Care for Me), we conducted a randomized, activecontrolled, trial of PCforMe. The primary outcome was the score on the System Usability Scale (SUS). Secondary outcomes were patient self-efficacy and change in knowledge. We compared PCforMe to three common online resources for patients seeking information about palliative care.Results. A total of 80 patients were randomized. There were no significant demographic differences. Mean SUS score for PCforMe was 78.2, significantly above the normative average SUS score of 68 (P-value < 0.0001). Mean change in Perceived Efficacy in Patient-Physician Interactions score was À2.2 for PCforMe and À1.7 for control group (P-value ¼ 0.72). Preparedness for an upcoming palliative care visit increased 50% in the intervention group and 13.3% in the control group. Difference in the number of patients with improved knowledge regarding palliative care approached significance (P ¼ 0.06). Lastly, we found that the no-show rate was lower during Q1 2017 (during trial) and Q1 2016 (before trial), at 11.7% and 21%, respectively (P < 0.05). Comparing the full calendar year (CY) 2016 with 2017, we did not find a statistical difference (CY 2016 of 18.8% and 15% in CY 2017; P ¼ 0.22). Conclusion.PCforMe is a usable mobile health tool to prepare patients for an upcoming palliative care appointment. Further research is needed to test effectiveness.
Background: Pancreatic cancer has a poor 5-year survival and carries significant morbidity. Pain is a commonly studied symptom in pancreatic cancer; however, few studies examine the frequency of multiple patient-reported symptoms. Our aim is to ascertain patient-reported symptom burden at initial consultation with a palliative care provider and compare patient prognostic awareness to provider estimation of prognosis. Methods: Data were extracted from the standardized Quality Data Collection Tool (QDACT). Adults with pancreatic cancer seen by a palliative care provider were included. Descriptive statistics were used to describe demographic features, symptom prevalence and burden, as well as assess patient prognosis awareness defined by congruence or incongruence with provider estimated prognosis. Results: 285 patients were included in our analysis. The average age was 68 years (SD: 12.4), 87.2% were white, 50% male. The mean number of moderate/severe symptoms was 2.6 (SD: 2) out of 9 symptoms. Tiredness (66.7%), appetite (64.5%) and pain (46.2%) had the highest rates of moderate/severe symptom burden. Patients with a prognosis of 1-6 months had the lowest proportion of congruence with provider estimation (56.5%). Conclusion: Our study suggests targets to improve patient-centered care of pancreatic cancer. Patients commonly have multiple symptoms that are moderate/severe at time of palliative care referral. While pain has been well-reported, tiredness and decreased appetite are more prevalent at initial visit. This emphasizes the importance of assessing multiple symptoms and working closely with palliative care for early referral. Overall, one third of patient prognosis estimates differed from the provider assessment of prognosis. Our data support the importance of early referral to palliative care to manage symptoms and better prepare patients for end-of-life care.
5021 Background: We have shown previously in multivariable analysis that AA men had 19% lower risk of death than C men with metastatic castration resistant prostate cancer (mCRPC) treated with a docetaxel (D) and prednisone (P) based regimen. The primary goal of this analysis was to compare ≥50%PSA decline and objective response rate (ORR) in C men, AA men, and Asian men with mCRPC treated with a DP based regimen. Methods: Individual patient data from 8,151 mCRPC men randomized on eight phase III trials to a D containing regimen were combined. Race used in the analysis was based on self-report. The endpoints were ≥50% PSA decline from baseline defined by the PSA working group 2 and ORR (defined as complete or partial response). The logistic regression model was employed to assess the prognostic importance of race in predicting ≥50% PSA decline and ORR adjusting for treatment arm, performance status, and site of metastases. Results: Of 8,151, 7,687 (94%) patients had evaluable PSA data. Of 7,687 men, 6,535 (85%) were W, 445 (6%) were B, 395 (5%) were Asian and 312 (4%) had race unspecified. Men with race unspecified were excluded from the analysis, leaving 7,375 men. Percentage of patients who experienced PSA decline from baseline were: 64%, 58% and 62% in W, B and Asian men, respectively. In multivariable analysis adjusting for risk factors, the pooled odds ratios for PSA decline for AA vs. W were 0.9 (95% CI = 0.7-1.1, p = 0.16) and 1.0 (95% CI = 0.8-1.2, p = 0.92) for Asian vs. W. In 2,760 patients with measurable disease, the percentage of patients who had ORR were: 39%, 31% and 34% in W, B and Asian men, respectively. In multivariable analysis, the pooled odds ratios for ORR were 1.0 (95% CI = 0.7-1.4) for B vs. W and 0.9 (95% CI = 0.6-1.4) for Asian vs. W. Conclusions: There were no differences in PSA decline and ORR outcomes in W, B, or Asian men with mCRPC enrolled on these phase III clinical trials with DP. Clinical trial information: NCT00110214.
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