A phase II mixed-methods study on early integration of palliative care in advanced respiratory and gastrointestinal cancer patients


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Massimo Costantini1
1Hospital of Santa Maria Nuova, Florence, Italy

Abstract

Aims

Assessing feasibility, acceptability, and perceived efficacy of early palliative care integration for newly diagnosed advanced respiratory and digestive cancer patients.

Methods

Oncologists and pneumologists of two outpatient clinics were asked to offer to 40 consecutive newly diagnosed eligible patients the early palliative care (PC) intervention together with standard oncological care. Eligibility criteria were: diagnosis within 8 weeks of advanced lung, pleural, stomach and pancreas cancer, PS of 0-2, and having not started chemotherapy yet. The intervention was provided by a specialised hospital based PC team (PCT) through at least monthly (or more frequent) consultations until death, referral to community teams, refusal, or other reasons. A semi-structured interview was administered to six patients, six family caregivers and six physicians to explore perceived efficacy, strengths and weaknesses of the intervention. Transcripts were analysed using content analysis.

Results

Fifty-seven of 136 consecutive newly diagnosed cancer patients were eligible. Physicians proposed the intervention to 44 patients (77.2%). Reasons for not proposal were staff error (n=2), a competitive trial (n=1), patient living out of place (n=2), and patient needing to start chemotherapy immediately (n=8). Only 4 out of the 44 patients (9.1%) refused the PC intervention. Thirty-nine patients attended the first visit with the PCT (one retired the consent). Preliminary results from qualitative analysis showed that all patients and most relatives referred on the usefulness of the PC intervention with reference to its main focus, i.e. symptom management, information, and support to strategies employed to cope with illness. Physicians highlighted their difficulty in informing eligible patients on the PC intervention, and in sharing information and coordinating care with colleagues of the PCT.

Conclusion

Early integration of palliative care in oncology seems to be both feasible and well accepted by patients, relatives and physicians, although some difficulties emerged concerning patient information and inter-professional communication.