Symptom screening with Targeted Early Palliative care (STEP) versus usual care for patients with advanced cancer: a mixed methods study.

Autor:	Zimmermann C; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. camilla.zimmermann@uhn.ca.; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. camilla.zimmermann@uhn.ca.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada. camilla.zimmermann@uhn.ca.; Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada. camilla.zimmermann@uhn.ca.; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada. camilla.zimmermann@uhn.ca., Pope A; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Hannon B; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada., Bedard PL; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.; Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Rodin G; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada., Dhani N; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.; Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Li M; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada., Herx L; Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, Canada., Krzyzanowska MK; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.; Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Howell D; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Faculty of Nursing, University of Toronto, Toronto, Canada., Knox JJ; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.; Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Leighl NB; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.; Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Sridhar S; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.; Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Oza AM; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.; Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Lheureux S; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.; Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Booth CM; Division of Medical Oncology, Kingston Health Sciences Centre, Kingston, Canada.; Department of Oncology, Queen's University, Kingston, Canada.; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada., Liu G; Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.; Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Castro JA; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.; Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada., Swami N; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Sue-A-Quan R; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Rydall A; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada., Le LW; Department of Biostatistics, University Health Network, Toronto, Canada.
Jazyk:	angličtina
Zdroj:	Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2023 Jun 21; Vol. 31 (7), pp. 404. Date of Electronic Publication: 2023 Jun 21.
DOI:	10.1007/s00520-023-07870-9
Abstrakt:	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. (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze:	MEDLINE
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