Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach
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To prospectively compare outcomes and processes of hospital-based early palliative care with standard care in surgical oncology patients (N = 152).
A randomized, mixed methods, longitudinal study evaluated the effectiveness of a hospital-based Pain and Palliative Care Service (PPCS). Interviews were conducted presurgically and at follow-up visits up to 1 year. Primary outcome measures included the Gracely Pain Intensity and Unpleasantness Scales and the Symptom Distress Scale. Qualitative interviews assessed social support, satisfaction with care, and communication with providers. Survival analysis methods explored factors related to treatment crossover and study discontinuation. Models for repeated measures within subjects over time explored treatment and covariate effects on patient-reported pain and symptom distress.
None of the estimated differences achieved statistical significance; however, for those who remained on study for 12 months, the PPCS group performed better than their standard of care counterparts. Patients identified consistent communication, emotional support, and pain and symptom management as positive contributions delivered by the PPCS.
It is unclear whether lower pain perceptions despite greater symptom distress were clinically meaningful; however, when coupled with the patients’ perceptions of their increased resources and alternatives for pain control, one begins to see the value of an integrated PPCS.
- Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach
Quality of Life Research
Volume 21, Issue 3 , pp 405-415
- Cover Date
- Print ISSN
- Online ISSN
- Springer Netherlands
- Additional Links
- Cancer malignancies
- Palliative care
- Pain management
- Symptom management
- Mixed methods
- Industry Sectors
- Author Affiliations
- 1. National Institutes of Health Clinical Center, Building 10, Room 2B14, 10 Center Drive, Bethesda, MD, 20892, USA
- 2. Pain and Palliative Care Service, National Institutes of Health Clinical Center, 10 Center Drive, 2-1733 MSC 1517, Bethesda, MD, 20892, USA
- 3. United BioSource Corporation, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA
- 4. Shenandoah University, 348 Renaissance Drive, Martinsburg, WV, 25403, USA
- 5. National Institutes of Health Clinical Center, 5207 Dorset Avenue, Chevy Chase, MD, 20815, USA
- 6. Palliative Care Department, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA
- 7. National Institutes of Health, National Cancer Institute, 6130 Executive Boulevard, Bethesda, MD, 20892, USA