Randomized Trial of a Palliative Care Intervention to Improve End-of-Life Care Discussions in Patients With Metastatic Breast Cancer
(2022) In JNCCN Journal of the National Comprehensive Cancer Network 20(2). p.136-143- Abstract
Background: Studies show that early, integrated palliative care (PC) improves quality of life (QoL) and end-of-life (EoL) care for patients with poor-prognosis cancers. However, the optimal strategy for delivering PC for those with advanced cancers who have longer disease trajectories, such as metastatic breast cancer (MBC), remains unknown. We tested the effect of a PC intervention on the documentation of EoL care discussions, patient-reported outcomes, and hospice utilization in this population. Patients and Methods: Patients with MBC and clinical indicators of poor prognosis (n5120) were randomly assigned to receive an outpatient PC intervention (n561) or usual care (n559) between May 2, 2016, and December 26, 2018, at an academic... (More)
Background: Studies show that early, integrated palliative care (PC) improves quality of life (QoL) and end-of-life (EoL) care for patients with poor-prognosis cancers. However, the optimal strategy for delivering PC for those with advanced cancers who have longer disease trajectories, such as metastatic breast cancer (MBC), remains unknown. We tested the effect of a PC intervention on the documentation of EoL care discussions, patient-reported outcomes, and hospice utilization in this population. Patients and Methods: Patients with MBC and clinical indicators of poor prognosis (n5120) were randomly assigned to receive an outpatient PC intervention (n561) or usual care (n559) between May 2, 2016, and December 26, 2018, at an academic cancer center. The intervention entailed 5 structured PC visits focusing on symptom management, coping, prognostic awareness, decision-making, and EoL planning. The primary outcome was documentation of EoL care discussions in the electronic health record (EHR). Secondary outcomes included patient-report of discussions with clinicians about EoL care, QoL, and mood symptoms at 6, 12, 18, and 24 weeks after baseline and hospice utilization. Results: The rate of EoL care discussions documented in the EHR was higher among intervention patients versus those receiving usual care (67.2% vs 40.7%; P5.006), including a higher completion rate of a Medical Orders for Life-Sustaining Treatment form (39.3% vs 13.6%; P5.002). Intervention patients were also more likely to report discussing their EoL care wishes with their doctor (odds ratio [OR], 3.10; 95% CI, 1.21-7.94; P5.019) and to receive hospice services (OR, 4.03; 95% CI, 1.10-14.73; P5.035) compared with usual care patients. Study groups did not differ in patient-reported QoL or mood symptoms. Conclusions: This PC intervention significantly improved rates of discussion and documentation regarding EoL care and delivery of hospice services among patients with MBC, demonstrating that PC can be tailored to address the supportive care needs of patients with longer disease trajectories.
(Less)
- author
- publishing date
- 2022-02
- type
- Contribution to journal
- publication status
- published
- subject
- in
- JNCCN Journal of the National Comprehensive Cancer Network
- volume
- 20
- issue
- 2
- pages
- 8 pages
- publisher
- Harborside
- external identifiers
-
- pmid:35130492
- scopus:85124257483
- ISSN
- 1540-1405
- DOI
- 10.6004/jnccn.2021.7040
- language
- English
- LU publication?
- no
- additional info
- Funding Information: Funding: This work was supported by funding from NCCN/Pfizer Independent Grants for Learning & Change (PI: J.S. Temel). Publisher Copyright: © 2022 Harborside Press. All rights reserved.
- id
- bebef096-918f-4c1c-9308-fdc6bed64751
- date added to LUP
- 2023-04-18 11:13:32
- date last changed
- 2024-04-19 20:47:55
@article{bebef096-918f-4c1c-9308-fdc6bed64751,
abstract = {{<p>Background: Studies show that early, integrated palliative care (PC) improves quality of life (QoL) and end-of-life (EoL) care for patients with poor-prognosis cancers. However, the optimal strategy for delivering PC for those with advanced cancers who have longer disease trajectories, such as metastatic breast cancer (MBC), remains unknown. We tested the effect of a PC intervention on the documentation of EoL care discussions, patient-reported outcomes, and hospice utilization in this population. Patients and Methods: Patients with MBC and clinical indicators of poor prognosis (n5120) were randomly assigned to receive an outpatient PC intervention (n561) or usual care (n559) between May 2, 2016, and December 26, 2018, at an academic cancer center. The intervention entailed 5 structured PC visits focusing on symptom management, coping, prognostic awareness, decision-making, and EoL planning. The primary outcome was documentation of EoL care discussions in the electronic health record (EHR). Secondary outcomes included patient-report of discussions with clinicians about EoL care, QoL, and mood symptoms at 6, 12, 18, and 24 weeks after baseline and hospice utilization. Results: The rate of EoL care discussions documented in the EHR was higher among intervention patients versus those receiving usual care (67.2% vs 40.7%; P5.006), including a higher completion rate of a Medical Orders for Life-Sustaining Treatment form (39.3% vs 13.6%; P5.002). Intervention patients were also more likely to report discussing their EoL care wishes with their doctor (odds ratio [OR], 3.10; 95% CI, 1.21-7.94; P5.019) and to receive hospice services (OR, 4.03; 95% CI, 1.10-14.73; P5.035) compared with usual care patients. Study groups did not differ in patient-reported QoL or mood symptoms. Conclusions: This PC intervention significantly improved rates of discussion and documentation regarding EoL care and delivery of hospice services among patients with MBC, demonstrating that PC can be tailored to address the supportive care needs of patients with longer disease trajectories.</p>}},
author = {{Greer, Joseph A. and Moy, Beverly and El-Jawahri, Areej and Jackson, Vicki A. and Kamdar, Mihir and Jacobsen, Juliet and Lindvall, Charlotta and Shin, Jennifer A. and Rinaldi, Simone and Carlson, Heather A. and Sousa, Angela and Gallagher, Emily R. and Li, Zhigang and Moran, Samantha and Ruddy, Magaret and Anand, Maya V. and Carp, Julia E. and Temel, Jennifer S.}},
issn = {{1540-1405}},
language = {{eng}},
number = {{2}},
pages = {{136--143}},
publisher = {{Harborside}},
series = {{JNCCN Journal of the National Comprehensive Cancer Network}},
title = {{Randomized Trial of a Palliative Care Intervention to Improve End-of-Life Care Discussions in Patients With Metastatic Breast Cancer}},
url = {{http://dx.doi.org/10.6004/jnccn.2021.7040}},
doi = {{10.6004/jnccn.2021.7040}},
volume = {{20}},
year = {{2022}},
}