Is early integration of palliative home care in oncology treatment feasible and acceptable for advanced cancer patients and their health care providers? A phase 2 mixed-methods study

Abstract

Background To support the early integration of palliative home care (PHC) in cancer treatment, we developed the EPHECT intervention and pilot tested it with 30 advanced cancer patients in Belgium using a pre post design with no control group. We aim to determine the feasibility, acceptability and perceived effectiveness of the EPHECT intervention. Methods Interviews with patients (n = 16 of which 11 dyadic with family caregivers), oncologists and GPs (n = 11) and a focus group with the PHC team. We further analyzed the study materials and logbooks of the PHC team (n = 8). Preliminary effectiveness was assessed with questionnaires EORTC QLQ C-30, HADS and FAMCARE and were filled in at baseline and 12, 18 and 24 weeks. Results In the interviews after the intervention period, patients reported feelings of safety and control and an optimized quality of life. The PHC team could focus on more than symptom management because they were introduced earlier in the trajectory of the patient. Telephone-based contact appeared to be insufficient to support interprofessional collaboration. Furthermore, some family caregivers reported that the nurse of the PHC team was focused little on them. Conclusion Nurses of PHC teams are able to deliver early palliative care to advanced cancer patients. However, more attention needs to be given to family caregivers as caregiver and client. Furthermore, the home visits by the PHC team have to be further evaluated and adapted. Lastly, professionals have to find a more efficient way to discuss future care.

The feasibility of triggers for the integration of Standardised, Early Palliative (STEP) Care in advanced cancer: A phase II trial

“…Consistent with the exploratory study aims, the feasibility endpoint was determined by the authors primarily balancing pragmatic considerations around the available study timeframe. It was consistent with other phase II studies of this nature (34) and also considered the minimum sample required to determine a preliminary estimate of effect size for secondary patient-reported outcomes which would be the subject of a future phase III definitive trial.…”

Can an Integrated Palliative and Oncology Co-rounding Model Reduce Aggressive Care at the End of Life? Secondary Analysis of an Open-label Stepped-wedge Cluster-randomized Trial

“…[44][45][46][47] To tackle this problem, co-rounding could be adapted with integration of oncology with community-based palliative care. 48 Such a model extending into the community could be made feasible with rise of tele-collaboration use cases that allow "virtual co-rounding" between off-site oncologist and on-site community palliative care team, all within a patient's home. 49 Additionally, such consults can help prevent the sense of abandonment and lack of continuity often reported at end-of-life.…”

Patients’ experiences with shared decision-making in home-based palliative care – navigation through major life decisions

“…To ensure patient involvement in decisions about their health and wishes for the future, adequate information about treatment options and symptom relief is deemed an essential prerequisite for patients in need of palliative care [ 6 ]. Dhollander et al [ 7 ] found that patients experienced benefits from discussions with nurses concerning their preferences for the future. Nevertheless, their preferences regarding how they wished to be involved in the decision-making processes were not explored, nor was the significance of reflecting on their wishes clarified.…”

“…Nevertheless, their preferences regarding how they wished to be involved in the decision-making processes were not explored, nor was the significance of reflecting on their wishes clarified. Dhollander et al [ 7 ] also emphasized the importance of advance care planning (ACP), which is the creation of a plan for treatment intensity in the event of a worsening health condition based on the patient’s values, goals, and preferences [ 5 , 8 ]. Using such approach, Dhollander et al [ 7 ] underline the importance of an early integration of palliative care in the patient’s treatment from a home care perspective.…”