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Randomized Controlled Trial
. 2022 Feb;20(2):136-143.
doi: 10.6004/jnccn.2021.7040.

Randomized Trial of a Palliative Care Intervention to Improve End-of-Life Care Discussions in Patients With Metastatic Breast Cancer

Affiliations
Randomized Controlled Trial

Randomized Trial of a Palliative Care Intervention to Improve End-of-Life Care Discussions in Patients With Metastatic Breast Cancer

Joseph A Greer et al. J Natl Compr Canc Netw. 2022 Feb.

Abstract

Background: Studies show that early, integrated palliative care (PC) improves quality of life (QoL) and end-of-life (EoL) care for patients with poor-prognosis cancers. However, the optimal strategy for delivering PC for those with advanced cancers who have longer disease trajectories, such as metastatic breast cancer (MBC), remains unknown. We tested the effect of a PC intervention on the documentation of EoL care discussions, patient-reported outcomes, and hospice utilization in this population.

Patients and methods: Patients with MBC and clinical indicators of poor prognosis (n=120) were randomly assigned to receive an outpatient PC intervention (n=61) or usual care (n=59) between May 2, 2016, and December 26, 2018, at an academic cancer center. The intervention entailed 5 structured PC visits focusing on symptom management, coping, prognostic awareness, decision-making, and EoL planning. The primary outcome was documentation of EoL care discussions in the electronic health record (EHR). Secondary outcomes included patient-report of discussions with clinicians about EoL care, QoL, and mood symptoms at 6, 12, 18, and 24 weeks after baseline and hospice utilization.

Results: The rate of EoL care discussions documented in the EHR was higher among intervention patients versus those receiving usual care (67.2% vs 40.7%; P=.006), including a higher completion rate of a Medical Orders for Life-Sustaining Treatment form (39.3% vs 13.6%; P=.002). Intervention patients were also more likely to report discussing their EoL care wishes with their doctor (odds ratio [OR], 3.10; 95% CI, 1.21-7.94; P=.019) and to receive hospice services (OR, 4.03; 95% CI, 1.10-14.73; P=.035) compared with usual care patients. Study groups did not differ in patient-reported QoL or mood symptoms.

Conclusions: This PC intervention significantly improved rates of discussion and documentation regarding EoL care and delivery of hospice services among patients with MBC, demonstrating that PC can be tailored to address the supportive care needs of patients with longer disease trajectories. ClinicalTrials.gov identifier: NCT02730858.

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Figures

Figure 1.
Figure 1.
Study Flow Diagram
Figure 2.
Figure 2.
Clinician-Rated Adherence to Pre-Specified Topics across Five Structured PC Visits Note: Percentages represent the proportion of intervention patients whose palliative care clinicians discussed the pre-specified intervention topics for each structured visit per the study protocol. The sample sizes for the study visits decreased over time due to patient death, withdrawal, transfer of care, and lost to follow up (Visit 1 n=56, Visit 2 n=49, Visit 3 n=42, Visit 4 n=38, Visit 5 n=33).

References

    1. Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington (DC); 2015. - PubMed
    1. O’Connor TL, Ngamphaiboon N, Groman A, et al. Hospice utilization and end-of-life care in metastatic breast cancer patients at a comprehensive cancer center. J Palliat Med 2015; 18(1): 50–5. - PubMed
    1. Temel JS, Greer JA, Admane S, et al. Code status documentation in the outpatient electronic medical records of patients with metastatic cancer. J Gen Intern Med 2010; 25(2): 150–3. - PMC - PubMed
    1. Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008; 300(14): 1665–73. - PMC - PubMed
    1. Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ. Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol 2008; 26(23): 3860–6. - PMC - PubMed

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