Factors Associated with Improvement in Patient-reported Outcomes after Receiving Early Palliative Care

Background: Routine early palliative care (EPC) improves quality of life (QoL) for patients with advanced cancer, but it may not be necessary for all patients. We assessed the feasibility of Symptom screening with Targeted Early Palliative care (STEP) in a phase II trial. Methods: Patients with advanced cancer were recruited from medical oncology clinics. Symptoms were screened at each visit using the Edmonton Symptom Assessment System-revised (ESAS-r); moderate to severe scores (screen-positive) triggered an email to a palliative care nurse, who called the patient and offered EPC. Patient-reported outcomes of QoL, depression, symptom control, and satisfaction with care were measured at baseline and at 2, 4, and 6 months. The primary aim was to determine feasibility, according to predefined criteria. Secondary aims were to assess whether STEP identified patients with worse patient-reported outcomes and whether screen-positive patients who accepted and received EPC had better outcomes over time than those who did not receive EPC. Results: In total, 116 patients were enrolled, of which 89 (77%) completed screening for ≥70% of visits. Of the 70 screen-positive patients, 39 (56%) received EPC during the 6-month study and 4 (6%) received EPC after the study end. Measure completion was 76% at 2 months, 68% at 4 months, and 63% at 6 months. Among screen-negative patients, QoL, depression, and symptom control were substantially better than for screen-positive patients at baseline (all P<.0001) and remained stable over time. Among screen-positive patients, mood and symptom control improved over time for those who accepted and received EPC and worsened for those who did not receive EPC (P<.01 for trend over time), with no difference in QoL or satisfaction with care. Conclusions: STEP is feasible in ambulatory patients with advanced cancer and distinguishes between patients who remain stable without EPC and those who benefit from targeted EPC. Acceptance of the triggered EPC visit should be encouraged. ClinicalTrials.gov identifier: NCT04044040.

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Patient-reported outcomes across cerebrovascular event types

Neurology ◽

10.1212/wnl.0000000000006626 ◽

2018 ◽

Vol 91 (23) ◽

pp. e2182-e2191 ◽

Cited By ~ 10

Author(s):

Irene L. Katzan ◽

Andrew Schuster ◽

Christopher Newey ◽

Ken Uchino ◽

Brittany Lapin

Keyword(s):

Ischemic Stroke ◽

Executive Function ◽

Physical Function ◽

Patient Reported Outcomes ◽

Social Roles ◽

Factors Associated ◽

Cerebrovascular Events ◽

Patient Reported ◽

Health Domains ◽

Domain Scores

ObjectivesTo compare the degrees to which 8 domains of health are affected across types of cerebrovascular events and to identify factors associated with domain scores in different event types.MethodsThis was an observational cohort study of 2,181 patients with ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or TIA in a cerebrovascular clinic from February 17, 2015, to June 2, 2017 who completed Quality of Life in Neurologic Disorders executive function and the following Patient-Reported Outcomes Measurement Information System scales as part of routine care: physical function, satisfaction with social roles, fatigue, anxiety, depression, pain interference, and sleep disturbance.ResultsAll health domains were affected to similar degrees in patients with ICH, SAH, and ischemic stroke after adjustment for disability and other clinical factors, whereas patients with TIA had worse adjusted scores for 5 of the 8 domains of health. Female sex, younger age, lower income, and event <90 days were associated with worse scores in multiple domains. Factors associated with health domain scores were similar for all cerebrovascular events. Most affected domains for all were physical function, satisfaction with social roles, and executive function.ConclusionsThe subtype of stroke (ischemic stroke, ICH, and SAH) had similar effects in multiple health domains, while patients with TIA had worse adjusted outcomes, suggesting that the mechanisms for outcomes after TIA may differ from those of other cerebrovascular events. The most affected domains across all event types were physical function, satisfaction with social roles, and executive function, highlighting the need to develop effective interventions to improve these health domains in survivors of these cerebrovascular events.

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Effect of Short-term Integrated Palliative Care on Patient-Reported Outcomes Among Patients Severely Affected With Long-term Neurological Conditions

JAMA Network Open ◽

10.1001/jamanetworkopen.2020.15061 ◽

2020 ◽

Vol 3 (8) ◽

pp. e2015061 ◽

Cited By ~ 3

Author(s):

Wei Gao ◽

Rebecca Wilson ◽

Nilay Hepgul ◽

Deokhee Yi ◽

Catherine Evans ◽

...

Keyword(s):

Palliative Care ◽

Patient Reported Outcomes ◽

Short Term ◽

Patient Reported ◽

Neurological Conditions

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The Support, Education, and Advocacy (SEA) Program of Care for Women With Metastatic Breast Cancer: A Nurse-Led Palliative Care Demonstration Program

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119839696 ◽

2019 ◽

Vol 36 (10) ◽

pp. 864-870 ◽

Cited By ~ 4

Author(s):

Victoria Reiser ◽

Margaret Rosenzweig ◽

Ann Welsh ◽

Dianxu Ren ◽

Barbara Usher

Keyword(s):

Breast Cancer ◽

Palliative Care ◽

Social Service ◽

Patient Reported Outcomes ◽

Metastatic Breast ◽

Well Being ◽

Mean Difference ◽

Generalized Anxiety ◽

Supportive Services ◽

Patient Reported

Background: Women with metastatic breast cancer (MBC) experience unique symptom management and psychosocial needs due to aggressive, yet palliative treatment with a progressive, chronic illness. Objective: This article describes the effect of a quality improvement project for coordination of supportive care in MBC. Program evaluations included referral rates for supportive services, patient-reported outcomes of symptom distress, generalized anxiety, and overall well-being. Design: An interdisciplinary Support, Education and Advocacy Program (MBC-SEA) was developed. The 1-hour, weekly, patient review included collaborative assessments to determine needs for social service, psychological counseling, and palliative care. A prospective pre- and postexperimental cohort design with convenience sampling was used. Analysis was conducted with paired t test analysis of pre- and postimplementation outcomes. Setting/Participants: Program outcomes of 118 women with MBC visiting an urban outpatient breast cancer clinic during September 2016 to November 2016 (pre) and January 2017 to March 2017 (post) were evaluated. Measurements: Referral rates to social work and palliative care, symptom, anxiety, and overall well-being scores. Results: Following program implementation, referrals to palliative care and social work supportive services increased significantly including patient-reported outcomes symptom distress scores mean difference 1.4 (95% confidence interval [CI]: 0.4306-2.6428), P = .004; generalized anxiety scores mean difference 1.5 (95% CI: 0.5406-2.5781), P = .003; and overall well-being mean difference of −0.7 (95% CI: −1.3498 to −0.0570), P = .03. Conclusions: Purposeful nurse-led assessment for social service and palliative care needs increases referrals with improvement in patient-reported outcomes.

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Role of Patient Coping Strategies in Understanding the Effects of Early Palliative Care on Quality of Life and Mood

Journal of Clinical Oncology ◽

10.1200/jco.2017.73.7221 ◽

2018 ◽

Vol 36 (1) ◽

pp. 53-60 ◽

Cited By ~ 36

Author(s):

Joseph A. Greer ◽

Jamie M. Jacobs ◽

Areej El-Jawahri ◽

Ryan D. Nipp ◽

Emily R. Gallagher ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Depressive Symptoms ◽

Coping Strategies ◽

Indirect Effect ◽

Avoidant Coping ◽

Intervention Effects ◽

Early Palliative Care ◽

Patient Reported

Purpose The early integration of oncology and palliative care (EIPC) improves quality of life (QOL) and mood for patients with advanced cancer. However, the mechanisms by which EIPC benefits these outcomes remain unclear. We therefore examined whether EIPC improved patients’ coping strategies and if changes in coping accounted for intervention effects on QOL and depressive symptoms. Patients and Methods For this secondary analysis of an EIPC trial, we examined data from 350 patients with newly diagnosed incurable lung or GI cancer. Participants completed assessments of QOL (Functional Assessment of Cancer Therapy–General), depressive symptoms (Patient Health Questionnaire–9), and coping (Brief COPE) at baseline and 24 weeks. We used linear regression to test intervention effects on use of coping strategies and mediation regression models with bias-corrected bootstrapping to examine whether improvements in coping mediated the effects of early palliative care on patient-reported outcomes. Results Compared with usual oncology care, EIPC significantly increased patient use of approach-oriented coping strategies ( B = 1.09; SE = 0.44; P = .01) and slightly reduced use of avoidant strategies ( B = −0.44; SE = 0.23; P = .06) from baseline to 24 weeks. Also, the increased use of approach-oriented coping and reduction in avoidant coping were associated with higher QOL and lower depressive symptoms at 24 weeks. The positive changes in approach-oriented coping, but not avoidant coping, significantly mediated the effects of EIPC on QOL (indirect effect, 1.27; 95% CI, 0.33 to 2.86) and depressive symptoms (indirect effect, −0.39; 95% CI, −0.87 to −0.08). Conclusion Patients with incurable cancer who received EIPC showed increased use of approach-oriented coping, which was associated with higher QOL and reduced depressive symptoms. Palliative care may improve these outcomes by providing patients with the skills to cope effectively with life-threatening illness.

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Improving Patient-Reported Outcomes Collection Rate in an Outpatient Palliative Care Clinic (QI707)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2018.12.216 ◽

2019 ◽

Vol 57 (2) ◽

pp. 459-460

Author(s):

Isaac Chua ◽

Jocelyn Siegel ◽

Victoria Hayne ◽

Nadine McCleary

Keyword(s):

Palliative Care ◽

Patient Reported Outcomes ◽

Care Clinic ◽

Collection Rate ◽

Patient Reported

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Clinical and radiological factors associated with postoperative shoulder imbalance and correlation with patient-reported outcomes following scoliosis surgery

Journal of Orthopaedics ◽

10.1016/j.jor.2020.08.036 ◽

2020 ◽

Vol 21 ◽

pp. 465-472

Author(s):

Shailesh Hadgaonkar ◽

Shubham Shah ◽

Pramod Bhilare ◽

Ajay Kothari ◽

Ashok Shyam ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Scoliosis Surgery ◽

Factors Associated ◽

Patient Reported ◽

Postoperative Shoulder Imbalance ◽

Shoulder Imbalance ◽

Postoperative Shoulder

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Next steps: Incorporating patient-reported outcomes into palliative care referral for people with advanced breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.34_suppl.133 ◽

2018 ◽

Vol 36 (34_suppl) ◽

pp. 133-133

Author(s):

Yun Rose Li ◽

Celine Denise Marquez ◽

Hope S. Rugo ◽

Michael W. Rabow ◽

Laura Esserman

Keyword(s):

Breast Cancer ◽

Palliative Care ◽

Advanced Breast Cancer ◽

Severity Score ◽

Patient Reported Outcomes ◽

Metastatic Cancer ◽

Advanced Breast ◽

Patient Specific ◽

Patient Reported

133 Background: Specialty palliative care (SPC) has been shown to improve quality of life, reduce unnecessary health care utilization, reduce overall costs, and decrease mortality in some settings for patients with advanced or metastatic cancer, however only a small proportion are being promptly referred. As interventions that respond to patient reported outcomes (PROs) have been shown to improve symptoms and decrease mortality, we hypothesized that the rates of SPC referral would be increased by documenting, tracking, and presenting PROs for oncology visits to referring oncologists. Methods: Over a period of 2 months, 74 English-speaking established patients seen in an advanced breast cancer clinic with an embedded SPC service were approached and completed the study. All patients filled out the electronic, validated PROMIS and PRO-CTCAE PRO questionnaires in the waiting room using a touch screen tablet. Results were presented to the oncologist during the encounter if the CTCAE severity score exceeded 3 in at least 1 domain. Patient demographics, clinical features and PC referrals or appointments were assessed via chart review. Results: At baseline, 9 (12.2%) patients scored a minimum of “severe” (4/5 or 5/5) in at least 1 of the 3 anxiety domains; 17 (23.0%) had moderate-severe pain; and 27 (32.1%) reported fatigue. At study entry, 25 patients (33.8%) had been referred previously to the SPC service; 19 had actually been seen (76% of referred). Of the 63 (85.1%) patients with sufficient follow-up, 13 (20.6%) reported at least “severe” in >1 CTCAE domains, 6 (46.2%) of whom were previously referred to SPC. For the remaining 7 patients, median PROMIS T-score and PRO-CTCAE maximum severity score were 58.3 and 3.2, respectively; none were referred to SPC during the follow up period. Conclusions: The choice to refer (or not to refer) a patient to SPC is complex and tied to patient specific factors such as coordinating additional visits and fear of end of life conversations. To enable greater access to SPC, alternative referral mechanisms, such as group-based or personalized patient education, or automatic referrals triggered by evidence of need, may be required. #YRL/CDM contributed equally.

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