By Matt Silver
SAN FRANCISCO -- September 12, 2016 -- Coordinating physician-led specialty palliative care visits is challenging for patients with advanced pancreatic cancer, particularly for patients traveling from far away and unwilling or unable to make extra trips to the cancer centre, researchers reported here at the 2016 Palliative Care in Oncology Symposium.
They added that future palliative care intervention studies should examine implementation challenges related to recruitment, retention, intervention fidelity, and participant burden.
“Palliative care services should be tailored to meet patient needs,” said lead author Yael Schenker, MD, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania. “Long travel times, inconvenient scheduling, and having to come to the cancer centre on ‘good days’ -- rather than spending time with family -- may make these services less attractive to patients.”
The researchers assessed the feasibility, acceptability, and perceived effectiveness of early specialty physician-led palliative care in patients with advanced pancreatic cancer. They randomised 60 patients with borderline, locally-advanced, or metastatic pancreatic cancer to monthly specialty palliative care visits for 3 months plus standard oncology care or standard oncology care alone.
In the 3-month time period, 70% of participants in the intervention group completed at least 2 specialty palliative care visit and 15% completed 3 palliative care visits.
In semi-structured interviews, patients and caregivers noted that long travel times to the cancer centre, difficulty scheduling palliative care visits at a convenient time, and lengthy study assessments posed burdens.
The participating oncologists and palliative care physicians recommended more in-person communication between clinicians and tailoring palliative care visit content and schedules to match patient needs.
“Recognising the challenges encountered in this trial and the need for more feasible and easily disseminated palliative care interventions, we have developed a nurse-led intervention to provide ‘primary’ palliative care integrated within oncology clinics,” said Dr. Schenker. “We are currently testing the efficacy of this ‘primary’ palliative care intervention in a cluster-randomised trial.”
The 2016 Palliative Care in Oncology Symposium is cosponsored by the American Academy of Hospice and Palliative Medicine, the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Multinational Association of Supportive Care in Cancer.
[Presentation title: A Pilot Trial of Early Specialty Palliative Care for Patients With Advanced Pancreatic Cancer: Challenges Encountered and Lessons Learned. Abstract 110]
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