Care plus study: a multi-site implementation of early palliative care in routine practice to improve health outcomes and reduce hospital admissions for people with advanced cancer: a study protocol

doi:10.1186/s12913-021-06476-3

Clinical Trial

. 2021 May 27;21(1):513.

doi: 10.1186/s12913-021-06476-3.

Care plus study: a multi-site implementation of early palliative care in routine practice to improve health outcomes and reduce hospital admissions for people with advanced cancer: a study protocol

Jennifer Philip^{1

2

3

4}, Roslyn Le Gautier⁵, Anna Collins¹, Anna K Nowak⁶, Brian Le^{3

4}, Gregory B Crawford^{7

8}, Nicole Rankin⁹, Meinir Krishnasamy^{10

11

12}, Geoff Mitchell¹³, Sue-Anne McLachlan^{1

14}, Maarten IJzerman¹⁵, Robyn Hudson¹⁶, Danny Rischin^{1

17}, Tanara Vieira Sousa¹⁸, Vijaya Sundararajan^{1

19}

Affiliations

¹ Department of Medicine, University of Melbourne, Melbourne, Australia.
² Palliative Care Service, St Vincent's Hospital Melbourne, Melbourne, Australia.
³ Palliative Care Service, Royal Melbourne Hospital, Melbourne, Australia.
⁴ Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia.
⁵ Department of Medicine, University of Melbourne, Melbourne, Australia. Roslyn.legautier@unimelb.edu.au.
⁶ Medical School, University of Western Australia and Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Australia.
⁷ Northern Adelaide Local Health Network, Modbury Hospital, Adelaide, Australia.
⁸ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
⁹ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
¹⁰ Department of Nursing and Centre for Cancer Research, University of Melbourne, Melbourne, Australia.
¹¹ Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia.
¹² Victorian Comprehensive Cancer Centre, Melbourne, Australia.
¹³ School of Medicine, University of Queensland, Brisbane, Australia.
¹⁴ Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia.
¹⁵ Cancer Health Services Research, University of Melbourne, Melbourne, Australia.
¹⁶ Safer Care Victoria, Victoria State Government, Melbourne, Australia.
¹⁷ Department of Medical Oncology, Peter MacCallum Cancer Centr, Melbourne, Australia.
¹⁸ Centre for Health Policy, Health Economics Unit, University of Melbourne, Melbourne, Australia.
¹⁹ Department of Public Health, La Trobe University, Melbourne, Australia.

PMID: 34044840
PMCID: PMC8157619
DOI: 10.1186/s12913-021-06476-3

Clinical Trial

Care plus study: a multi-site implementation of early palliative care in routine practice to improve health outcomes and reduce hospital admissions for people with advanced cancer: a study protocol

Jennifer Philip et al. BMC Health Serv Res. 2021.

. 2021 May 27;21(1):513.

doi: 10.1186/s12913-021-06476-3.

Authors

Affiliations

¹ Department of Medicine, University of Melbourne, Melbourne, Australia.
² Palliative Care Service, St Vincent's Hospital Melbourne, Melbourne, Australia.
³ Palliative Care Service, Royal Melbourne Hospital, Melbourne, Australia.
⁴ Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia.
⁵ Department of Medicine, University of Melbourne, Melbourne, Australia. Roslyn.legautier@unimelb.edu.au.
⁶ Medical School, University of Western Australia and Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Australia.
⁷ Northern Adelaide Local Health Network, Modbury Hospital, Adelaide, Australia.
⁸ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
⁹ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
¹⁰ Department of Nursing and Centre for Cancer Research, University of Melbourne, Melbourne, Australia.
¹¹ Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia.
¹² Victorian Comprehensive Cancer Centre, Melbourne, Australia.
¹³ School of Medicine, University of Queensland, Brisbane, Australia.
¹⁴ Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia.
¹⁵ Cancer Health Services Research, University of Melbourne, Melbourne, Australia.
¹⁶ Safer Care Victoria, Victoria State Government, Melbourne, Australia.
¹⁷ Department of Medical Oncology, Peter MacCallum Cancer Centr, Melbourne, Australia.
¹⁸ Centre for Health Policy, Health Economics Unit, University of Melbourne, Melbourne, Australia.
¹⁹ Department of Public Health, La Trobe University, Melbourne, Australia.

PMID: 34044840
PMCID: PMC8157619
DOI: 10.1186/s12913-021-06476-3

Abstract

Background: Current international consensus is that 'early' referral to palliative care services improves cancer patient and family carer outcomes. In practice, however, these referrals are not routine. An approach which directly addresses identified barriers to early integration of palliative care is required. This protocol details a trial of a standardized model of early palliative care (Care Plus) introduced at key defined, disease-specific times or transition points in the illness for people with cancer. Introduced as a 'whole of system' practice change for identified advanced cancers, the key outcomes of interest are population health service use change. The aims of the study are to examine the effect of Care Plus implementation on (1) acute hospitalisation days in the last 3 months of life; (2) timeliness of access to palliative care; (3) quality and (4) costs of end of life care; and (5) the acceptability of services for people with advanced cancer.

Methods: Multi-site stepped wedge implementation trial testing usual care (control) versus Care Plus (practice change). The design stipulates 'control' periods when usual care is observed, and the process of implementing Care Plus which includes phases of planning, engagement, practice change and evaluation. During the practice change phase, all patients with targeted advanced cancers reaching the transition point will, by default, receive Care Plus. Health service utilization and unit costs before and after implementation will be collated from hospital records, and state and national health service administrative datasets. Qualitative data from patients, consumers and clinicians before and after practice change will be gathered through interviews and focus groups.

Discussion: The study outcomes will detail the impact and acceptability of the standardized integration of palliative care as a practice change, including recommendations for ongoing sustainability and broader implementation.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN 12619001703190 . Registered 04 December 2019.

Keywords: Health services; Implementation; Integrated care; Palliative care.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Multisite stepped-wedge implementation trial of early palliative care for patients with advanced cancer

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References

1. Collins A, Lethborg C, Philip J. The challenges and suffering of caring for people with primary malignant glioma: qualitative perspectives on improving current supportive and palliative care practices. BMJ Support Palliat Care. 2014;4(1):68–76. doi: 10.1136/bmjspcare-2012-000419. - DOI - PubMed
1. Philip J, Collins A, Brand C, Moore G, Lethborg C, Sundararajan V, et al. "I'm just waiting … ": an exploration of the experience of living and dying with primary malignant glioma. Support Care Cancer. 2014;22(2):389–397. doi: 10.1007/s00520-013-1986-1. - DOI - PubMed
1. Wang T, Molassiotis A, Chung B, Tan J. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018;17(96):1–29. - PMC - PubMed
1. Baile W, Palmer J, Bruera E, Parker P. Assessment of palliative care cancer patients' most important concerns. Support Care Cancer. 2011;19(4):475–481. doi: 10.1007/s00520-010-0839-4. - DOI - PubMed
1. Earp M, Sinnarajah A, Kerba M, Tang P, Rodriguez-Arguello J, King S, et al. Opportunity is the greatest barrier to providing palliative care to advanced colorectal cancerpatients: a survey of oncology clinicians. Curr Oncol. 2018;25(5):e480–e4e5. doi: 10.3747/co.25.4021. - DOI - PMC - PubMed

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[1] Collins A, Lethborg C, Philip J. The challenges and suffering of caring for people with primary malignant glioma: qualitative perspectives on improving current supportive and palliative care practices. BMJ Support Palliat Care. 2014;4(1):68–76. doi: 10.1136/bmjspcare-2012-000419. - DOI - PubMed

[2] Collins A, Lethborg C, Philip J. The challenges and suffering of caring for people with primary malignant glioma: qualitative perspectives on improving current supportive and palliative care practices. BMJ Support Palliat Care. 2014;4(1):68–76. doi: 10.1136/bmjspcare-2012-000419. - DOI - PubMed

[3] Philip J, Collins A, Brand C, Moore G, Lethborg C, Sundararajan V, et al. "I'm just waiting … ": an exploration of the experience of living and dying with primary malignant glioma. Support Care Cancer. 2014;22(2):389–397. doi: 10.1007/s00520-013-1986-1. - DOI - PubMed

[4] Philip J, Collins A, Brand C, Moore G, Lethborg C, Sundararajan V, et al. "I'm just waiting … ": an exploration of the experience of living and dying with primary malignant glioma. Support Care Cancer. 2014;22(2):389–397. doi: 10.1007/s00520-013-1986-1. - DOI - PubMed

[5] Wang T, Molassiotis A, Chung B, Tan J. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018;17(96):1–29. - PMC - PubMed

[6] Wang T, Molassiotis A, Chung B, Tan J. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018;17(96):1–29. - PMC - PubMed

[7] Baile W, Palmer J, Bruera E, Parker P. Assessment of palliative care cancer patients' most important concerns. Support Care Cancer. 2011;19(4):475–481. doi: 10.1007/s00520-010-0839-4. - DOI - PubMed

[8] Baile W, Palmer J, Bruera E, Parker P. Assessment of palliative care cancer patients' most important concerns. Support Care Cancer. 2011;19(4):475–481. doi: 10.1007/s00520-010-0839-4. - DOI - PubMed

[9] Earp M, Sinnarajah A, Kerba M, Tang P, Rodriguez-Arguello J, King S, et al. Opportunity is the greatest barrier to providing palliative care to advanced colorectal cancerpatients: a survey of oncology clinicians. Curr Oncol. 2018;25(5):e480–e4e5. doi: 10.3747/co.25.4021. - DOI - PMC - PubMed

[10] Earp M, Sinnarajah A, Kerba M, Tang P, Rodriguez-Arguello J, King S, et al. Opportunity is the greatest barrier to providing palliative care to advanced colorectal cancerpatients: a survey of oncology clinicians. Curr Oncol. 2018;25(5):e480–e4e5. doi: 10.3747/co.25.4021. - DOI - PMC - PubMed

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Care plus study: a multi-site implementation of early palliative care in routine practice to improve health outcomes and reduce hospital admissions for people with advanced cancer: a study protocol

Affiliations

Care plus study: a multi-site implementation of early palliative care in routine practice to improve health outcomes and reduce hospital admissions for people with advanced cancer: a study protocol

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical