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01-12-2020 | Care | Original Article

Embedded palliative care for patients with metastatic colorectal cancer: a mixed-methods pilot study

Authors: Kara E. Bischoff, Carly Zapata, Sarah Sedki, Carling Ursem, David L. O’Riordan, Ashley Eaton England, Nicole Thompson, Ariceli Alfaro, Michael W. Rabow, Chloe E. Atreya

Published in: Supportive Care in Cancer | Issue 12/2020

Abstract

Purpose

Palliative care is recommended for patients with metastatic cancer, but there has been limited research about embedded palliative care for specific patient populations. We describe the impact of a pilot program that provided routine, early, integrated palliative care to patients with metastatic colorectal cancer.

Methods

Mixed methods pre-post intervention cohort study at an academic cancer center. Thirty control then 30 intervention patients with metastatic colorectal cancer were surveyed at baseline and 1, 3, 6, 9, and 12 months thereafter about symptoms, quality-of-life, and likelihood of cure. We compared survey responses, trends over time, rates of advance care planning, and healthcare utilization between groups. Patients, family caregivers, and clinicians were interviewed.

Results

Patients in the intervention group were followed for an average of 6.5 months and had an average of 3.5 palliative care visits. At baseline, symptoms were mild (average 1.85/10) and 78.2% of patients reported good/excellent quality-of-life. Half (50.9%) believed they were likely to be cured of cancer. Over time, symptoms and quality-of-life metrics remained similar between groups, however intervention patients were more realistic about their likelihood of cure (p = 0.008). Intervention patients were more likely to have a surrogate documented (83.3% vs. 26.7%, p < 0.0001), an advance directive completed (63.3% vs. 13.3%, p < 0.0001), and non-full code status (43.3% vs. 16.7%, p < 0.03). All patients and family caregivers would recommend the program to others with cancer.

Conclusions

We describe the impact of an embedded palliative care program for patients with metastatic colorectal cancer, which improved prognostic awareness and rates of advance care planning.

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Title: Embedded palliative care for patients with metastatic colorectal cancer: a mixed-methods pilot study
Authors: Kara E. Bischoff
Carly Zapata
Sarah Sedki
Carling Ursem
David L. O’Riordan
Ashley Eaton England
Nicole Thompson
Ariceli Alfaro
Michael W. Rabow
Chloe E. Atreya
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Care
Colorectal Cancer
Colorectal Cancer
Published in: Supportive Care in Cancer / Issue 12/2020
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-020-05437-6

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