Symptom screening with targeted early palliative care (STEP) versus usual care for patients with advanced cancer : a mixed methods study

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ZIMMERMANN, Camilla | POPE, Ashley | HANNON, Breffni | BEDARD, Philippe L. | RODIN, Gary | DHANI, Neesha | LI, Madeline | HERX, Leonie | KRZYZANOWSKA, Monika K. | HOWELL, Doris | KNOX, Jennifer J. | LEIGHL, Natasha B. | SRIDHAR, Srikala | OZA, Amit M. | LHEUREUX, Stephanie | BOOTH, Christopher M. | LIU, Geoffrey | ALCALDE CASTRO, Jacqueline | SWAMI, Nadia | SUE-A-QUAN, Rachel | RYDALL, Anne | LE, Lisa W.

PURPOSE: Although early palliative care is recommended, resource limitations prevent its routine implementation. We report on the preliminary findings of a mixed methods study involving a randomized controlled trial (RCT) of Symptom screening with Targeted Early Palliative care (STEP) and qualitative interviews. METHODS: Adults with advanced solid tumors and an oncologist-estimated prognosis of 6-36 months were randomized to STEP or symptom screening alone. STEP involved symptom screening at each outpatient oncology visit; moderate to severe scores triggered an email to a palliative care nurse, who offered referral to in-person outpatient palliative care. Patient-reported outcomes of quality of life (FACT-G7; primary outcome), depression (PHQ-9), symptom control (ESAS-r-CS), and satisfaction with care (FAMCARE P-16) were measured at baseline and 2, 4, and 6 months. Semi-structured interviews were conducted with a subset of participants. RESULTS: From Aug/2019 to Mar/2020 (trial halted due to COVID-19 pandemic), 69 participants were randomized to STEP (n = 33) or usual care (n = 36). At 6 months, 45% of STEP arm patients and 17% of screening alone participants had received palliative care (p = 0.009). Nonsignificant differences for all outcomes favored STEP: difference in change scores for FACT-G7 = 1.67 (95% CI: -1.43, 4.77); ESAS-r-CS = -5.51 (-14.29, 3.27); FAMCARE P-16 = 4.10 (-0.31, 8.51); PHQ-9 = -2.41 (-5.02, 0.20). Sixteen patients completed qualitative interviews, describing symptom screening as helpful to initiate communication; triggered referral as initially jarring but ultimately beneficial; and referral to palliative care as timely. CONCLUSION: Despite lack of power for this halted trial, preliminary results favored STEP and qualitative results demonstrated acceptability. Findings will inform an RCT of combined in-person and virtual STEP.

http://dx.doi.org/10.1007/s00520-023-07870-9

Voir la revue «Supportive care in cancer, 31»

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