Quality of Life Research

, Volume 21, Issue 3, pp 405–415

Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach

  • Gwenyth R. Wallen
  • Karen Baker
  • Marilyn Stolar
  • Claiborne Miller-Davis
  • Nancy Ames
  • Jan Yates
  • Jacques Bolle
  • Donna Pereira
  • Diane St. Germain
  • Daniel Handel
  • Ann Berger
Article

DOI: 10.1007/s11136-011-0065-7

Cite this article as:
Wallen, G.R., Baker, K., Stolar, M. et al. Qual Life Res (2012) 21: 405. doi:10.1007/s11136-011-0065-7

Abstract

Purpose

To prospectively compare outcomes and processes of hospital-based early palliative care with standard care in surgical oncology patients (N = 152).

Methods

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.

Results

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.

Conclusions

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.

Keywords

Cancer malignanciesPalliative carePain managementSymptom managementMixed methods

Abbreviations

PPCS

Pain and Palliative Care Service

NIH

Institutes of Health

CC

Clinical Center

NCI

National Cancer Institute

IRB

Institutional Review Board

ICU

Intensive Care Unit

APACHE II

The Acute Physiology and Chronic Health Evaluation

GPS

Gracely Pain Scales

SDS

Symptom Distress Scale

CES-D

Center for Epidemiologic Studies Depression Scale

Copyright information

© Springer Science+Business Media B.V. (outside the USA) 2011

Authors and Affiliations

  • Gwenyth R. Wallen
    • 1
  • Karen Baker
    • 2
  • Marilyn Stolar
    • 3
  • Claiborne Miller-Davis
    • 1
  • Nancy Ames
    • 1
  • Jan Yates
    • 4
  • Jacques Bolle
    • 5
  • Donna Pereira
    • 6
  • Diane St. Germain
    • 7
  • Daniel Handel
    • 2
  • Ann Berger
    • 2
  1. 1.National Institutes of Health Clinical CenterBethesdaUSA
  2. 2.Pain and Palliative Care ServiceNational Institutes of Health Clinical CenterBethesdaUSA
  3. 3.United BioSource CorporationLexingtonUSA
  4. 4.Shenandoah UniversityMartinsburgUSA
  5. 5.National Institutes of Health Clinical CenterChevy ChaseUSA
  6. 6.Palliative Care DepartmentGeorge Washington University HospitalWashingtonUSA
  7. 7.National Institutes of HealthNational Cancer InstituteBethesdaUSA