ADVANCE – Advance Care Planning; an Innovative Palliative Care Intervention to Improve Quality of Life in Cancer Patients – a Multi-Centre Cluster Randomized Clinical Trial – FP7 Project

Impact ◽  
2017 ◽  
Vol 2017 (4) ◽  
pp. 37-39 ◽  
Author(s):  
Ida Korfage ◽  
Judith Rietjens ◽  
Agnes van der Heide
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Palliative Care ◽  
Cancer Patients ◽  
Care Planning ◽  
Improve Quality ◽  
Care Intervention ◽  
Advance Care ◽  
Cluster Randomized

Outcomes Associated with End-of-Life Discussions (DRAFT)

2018 ◽  
Author(s):  
Masanori Mori
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advanced Cancer Patients ◽  
Advance Care ◽  
Aggressive Care

Physicians and advanced cancer patients are often reluctant to talk about death. They frequently avoid end-of-life discussions (EOLds), although such conversations are essential to initiate advance care planning. In this prospective, a longitudinal multisite cohort study of advanced cancer patients and their informal caregivers, the authors suggested cascading benefits of EOLds between patients and their physicians. In total, 123 of 332 (37.0%) patients reported having EOLds with their physicians at baseline. EOLds were not associated with higher rates of emotional distress or psychiatric disorders. Instead, after propensity-score weighted adjustment, EOLds were associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care was associated with worse patient quality of life and worse bereavement adjustment. These findings may help destigmatize EOLds and assist physicians and patients in initiating such conversations and engaging in advance care planning.

scholarly journals A randomized trial of a specialist palliative care intervention for patients undergoing surgery for cancer: rationale and design of the Surgery for Cancer with Option of Palliative Care Expert (SCOPE) Trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Myrick C. Shinall ◽  
Aimee Hoskins ◽  
Alexander T. Hawkins ◽  
Christina Bailey ◽  
Alaina Brown ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Randomized Controlled Trial ◽  
Cancer Patients ◽  
Controlled Trial ◽  
Specialist Palliative Care ◽  
Randomized Controlled ◽  
Care Intervention ◽  
Scope Trial

Abstract Background In medical oncology settings, early specialist palliative care interventions have demonstrated improvements in patient quality of life and survival compared with usual oncologic care. However, the effect of early specialist palliative care interventions in surgical oncology settings is not well studied. Methods The Surgery for Cancer with Option for Palliative Care Expert (SCOPE) Trial is a single-center, prospective, single-blind, randomized controlled trial of a specialist palliative care intervention for cancer patients undergoing non-palliative surgery. It will enroll 236 patients scheduled for major abdominal operations for malignancy, who will be randomized 1:1 at enrollment to receive usual care (control arm) or specialist palliative care consultation (intervention arm). Intervention arm patients will receive consultations from a palliative care specialist (physician or nurse practitioner) preoperatively and postoperatively. The primary outcome is physical and functional wellbeing at 90 days postoperatively. Secondary outcomes are quality of life at 90 days postoperatively, posttraumatic stress disorder symptoms at 180 days postoperatively, days alive at home without an emergency room visit in the first 90 postoperative days, and overall survival at 1 year postoperatively. Participants will be followed for 3 years after surgery for exploratory analyses of their ongoing quality of life, healthcare utilization, and mortality. Discussion SCOPE is an ongoing randomized controlled trial evaluating specialist palliative care interventions for cancer patients undergoing non-palliative oncologic surgery. Findings from the study will inform ways to identify and improve care of surgical patients who will likely benefit from specialist palliative care services. Trial registration ClinicalTrials.gov Identifier: NCT03436290 First Registered: 16 February 2018 Enrollment Began: 1 March 2018 Last Update: 20 December 2018

scholarly journals Symptom burden, quality of life, advance care planning and the potential value of palliative care in severely ill haemodialysis patients

2003 ◽  
Vol 18 (7) ◽  
pp. 1345-1352 ◽  
Author(s):  
S. D. Weisbord ◽  
S. S. Carmody ◽  
F. J. Bruns ◽  
A. J. Rotondi ◽  
L. M. Cohen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Advance Care Planning ◽  
Symptom Burden ◽  
Care Planning ◽  
Potential Value ◽  
Advance Care

scholarly journals Palliative care in day-hospital for advanced cancer patients: a study protocol for a multicentre randomized controlled trial

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Laura Thery ◽  
Amélie Anota ◽  
Lorraine Waechter ◽  
Celine Laouisset ◽  
Timothee Marchal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Day Hospital ◽  
Advanced Cancer Patients ◽  
Advance Care

Abstract Background Team-based and timely integrated palliative care is a gold standard of care in oncology, but issues concerning its optimal organization remain. Palliative Care in Day-Hospital (PCDH) could be one of the most efficient service model of palliative care to deliver interdisciplinary and multidimensional care addressing the complex supportive care needs of patients with advanced cancer. We hypothesize that, compared to conventional outpatient palliative care, PCDH allows the clinical benefits of palliative care to be enhanced. Methods/design This study is a multicentre parallel group trial with stratified randomization. Patient management in PCDH will be compared to conventional outpatient palliative care. The inclusion criteria are advanced cancer patients referred to a palliative care team with an estimated life expectancy of more than 2 months and less than 1 year. The primary endpoint is health-related quality of life with deterioration-free survival based on the EORTC QLQ-C30 questionnaire. The secondary objectives are the following: increase in patient satisfaction with care using the EORTC PATSAT-C33 and OUT-PATSAT7 questionnaires, better understanding of the prognosis using the PTPQ questionnaire and advance care planning; decrease in the need for supportive care among relatives using the SCNS-P&C-F questionnaire, and reduction in end-of-life care aggressiveness. Patients will complete one to five questionnaires on a tablet before each monthly visit over 6 months and will be followed for 1 year. A qualitative study will take place, aiming to understand the specificity of palliative care management in PCDH. Cost-effectiveness, cost-utility and, an additional economic evaluation based on capability approach will be conducted from a societal point of view. Discussion The first strength of this study is that it combines the main relevant outcomes assessing integrated palliative care; patient quality of life and satisfaction; discussion of the prognosis and advance care planning, family well-being and end-of-life care aggressiveness. The second strength of the study is that it is a mixed-method study associating a qualitative analysis of the specificity of PCDH organization, with a medical-economic study to analyse the cost of care. Trial registration Name of the registry: IDRCB 2019-A03116–51 Trial registration number:NCT04604873 Date of registration: October 27, 2020 URL of trial registry record

scholarly journals Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003422
Author(s):  
Ida J. Korfage ◽  
Giulia Carreras ◽  
Caroline M. Arnfeldt Christensen ◽  
Pascalle Billekens ◽  
Louise Bramley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Care Planning ◽  
Shared Decision ◽  
Specialist Palliative Care ◽  
Cluster Randomised ◽  
Advance Care

Background Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. Methods and findings To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015–2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0–3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients’ age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients’ quality of life did not differ between intervention and control groups (T-score −1.8 versus −0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Conclusions Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. Trial registration ISRCTN registry ISRCTN63110516.

Patient perspectives on participation in phase 1 clinical trials.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 48-48
Author(s):  
Thomas J. Smith ◽  
Anna Cathy Williams ◽  
Betty R. Ferrell ◽  
Tami R. Borneman ◽  
Vincent Chung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
End Of Life Care ◽  
Phase 1 ◽  
Treatment Options ◽  
Disease Status ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

48 Background: Patients with solid tumors in Phase 1 clinical trials are at an important phase in the cancer trajectory. Understanding patients’ experiences can guide healthcare providers to provide optimum care. The main objectives of this study were to describe patient perspectives on participating in a Phase 1 trial, understand their disease status and treatment options and, to describe the impact of the disease and clinical trial participation on quality of life (QOL). Methods: Phase 1 patients (n = 30) who were participating in a larger randomized NCI-funded intervention trial (n = 470), were interviewed and tape recorded. The interviews were transcribed and content analysis methods were used to identify common themes. Results: Patients reported participating in the Phase 1 clinical trial because their doctors informed and encouraged them, they had no other treatment options if they wanted to live longer, or they wanted to help future cancer patients. Most patients believed that participation would improve or stabilize their illness and improve quality of life. They believed that when the clinical trial ended, there would be new treatments available. Participants reported that the physicians, nursing staff, social worker, and their families had been supportive. They reported that the treatment had been difficult on their families. Patients reported that compassion, cultural awareness, spiritual support, and the need for individual attention was important. There was little mention of end-of-life care or advance care planning. Conclusions: Patients participating in Phase 1 trials remain optimistic about treatment options while aware of their mortality. They have important needs for support to address quality of life concerns as well as better understanding their disease status, treatment options, and advance care planning for end of life care. Clinical trial information: NCT01828775.

scholarly journals Current Practice of Dutch Hospital-Based Palliative Care Teams: Advance Care Planning in Advanced Stages of Disease

2021 ◽  
Author(s):  
Iris Doorne ◽  
Dick L. Willems ◽  
Nadine Baks ◽  
Jelle Kuijper ◽  
Bianca. M. Buurman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Northwestern Part ◽  
Care Planning ◽  
Dutch Hospital ◽  
Palliative Care Teams ◽  
Advance Care

Abstract Background: Specialist palliative care teams (PCT) are consulted during hospital admission for advice on complex palliative care. These consultations need to be timely to prevent symptom burden and maintain quality of life. Insight into specialist PCTs may help improve the outcomes of palliative care. Methods: In this retrospective observational study, we analyzed qualitative and quantitative data of palliative care consultations in a six-month period in four general hospitals in the northwestern part of the Netherlands. Data were obtained from electronic medical records. Results: We extracted data from 336 consultations. The most common diagnoses were cancer (54.8%) and organ failure (26.8%). 40.2% of patients were restricted to a chair or bed and 52.3% had an estimated life expectancy of less than three months. Within two weeks after consultation, 53.2% of the patients died, and the median time until death was 11 days (range 191) after consultation. Most patients died in hospital (49.4%) but only 7.5% preferred to die in hospital. Consultations were mostly requested for advance care planning (31.6%). End-of-life preferences focused on last wishes and maintaining quality of life. Conclusion: This study shows that palliative care consultations focus on terminal care and are more crisis-oriented than prevention-oriented. Death often occurs too quickly after consultation for end-of-life preferences to be met and these preferences tend to focus on dying. Educating healthcare professionals on when to initiate palliative care would promote a more prevention-oriented approach. Factors that indicate the need for timely PCT consultation should be defined.

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