CONTINUUM: A single-arm pilot care transition intervention for hospitalized patients with advanced cancer.

Abstract

33 Background: Patients with advanced cancer are frequently hospitalized and experience burdensome transitions of care after discharge. Interventions to address patients’ symptoms, support medication management, and ensure continuity of care after discharge are lacking. We sought to demonstrate the feasibility and acceptability of CONTINUUM (CONTINUity of care Under Management by video visits) for this population. Methods: We conducted a single-arm pilot trial (n = 50) of CONTINUUM at Massachusetts General Hospital (MGH). The intervention consisted of a video visit with an oncology nurse practitioner (NP) within 3 business days of hospital discharge to address symptoms, medication management, hospitalization-related issues, and care coordination. Prior to discharge, we enrolled English-speaking adults with advanced breast, gastrointestinal, genitourinary, or thoracic cancers experiencing an unplanned hospitalization who were receiving ongoing oncology care at MGH and being discharged home without hospice services. We defined the intervention as feasible if ≥70% of approached and eligible patients enrolled and if ≥70% of enrolled patients completed the intervention within 3 business days of discharge. At 2 weeks after discharge, patients rated the ease of use of the video technology and stated whether they would recommend the intervention. NPs completed post-intervention surveys to assess fidelity to the intervention protocol. Results: From 01/07/21 to 05/28/21, we enrolled 50 patients (75% of patients approached). Of the enrolled patients (median age = 65 years; 62% and 22% had advanced gastrointestinal or thoracic cancers, respectively), 78% of enrolled patients received the intervention within 3 business days of discharge. Patient rating of the ease of use of video technology was a mean of 7.6 out of 10, with 72% stating they “agreed” or “strongly agreed” that they would recommend the intervention. NP post-intervention surveys revealed that visits primarily focused on symptom management (56%), followed by addressing post-hospital care issues (21%). Of the 30 patients with 30-day follow-up, 43% were readmitted within 30 days of discharge, and 17% died within 30 days of discharge. Conclusions: We found that CONTINUUM, which consists of an NP-delivered video visit soon after hospital discharge addressing patients’ symptoms, medications, and care coordination, represents a feasible and acceptable approach to provide post-discharge care for hospitalized patients with advanced cancer. Future studies will test the efficacy of the intervention for reducing hospital readmissions. Clinical trial information: NCT04640714.

Role of Patient-Reported Outcome Measures in the Inpatient Setting—Reply

“…However, as Dr Al-Rashdan astutely states, other unmeasured symptoms and/or factors could influence patients’ inpatient experience and thereby negate the potential effect of a systematic symptom monitoring intervention during hospitalization. In the future, when seeking to understand the utility of symptom monitoring interventions, investigators may consider other strategies (eg, enhanced care coordination, hospital-at-home models) and additional outcome measures (eg, patient satisfaction, health care utilization) to try to address the myriad factors influencing the hospitalization course for patients with cancer.…”