Reid Eleanor, Abathun Ephrem, Diribi Jilcha, Mamo Yoseph, Hall Peter, Fallon Marie, Wondemagegnhu Tigineh, Grant Liz
Yale University School of Medicine, New Haven, USA.
University of Edinburgh Global Health Academy, Edinburgh, UK.
Contemp Clin Trials Commun. 2020 Apr 6;18:100564. doi: 10.1016/j.conctc.2020.100564. eCollection 2020 Jun.
Patient-reported outcomes and economic aspects of Palliative Care (PC) provision in low-income countries (LIC) are under-studied. Demonstrating the economic value of PC is key to sustainability and guiding health care policy. Our preliminary data in Ethiopia demonstrated a widespread need for PC, poor access to it, and high out of pocket payments (OOP). We suspect that in this and other LIC, PC may function not only to reduce suffering but also as a poverty reduction strategy.We are conducting a randomized controlled trial of standard Oncology care versus standard Oncology care plus PC in newly diagnosed cancer patients in Addis Ababa. Ninety-seven adults presenting to Oncology Clinic will be randomized in a 1:1 ratio. Subjects receiving PC will meet with a PC provider at time of enrollment and at follow up visits in their homes. All subjects will be assessed via questionnaire at enrollment and follow-up Oncology visits at 8 ± 4 and 12 ± 4 weeks. A cost-consequence analysis will be performed, to include: patient-reported OOP and healthcare utilization, the latter to be assessed through chart adjudication. Outcomes will include change in African Palliative Care Association Palliative Outcome Score, changes in OOP and healthcare utilization.We hypothesize that the cost of home-based PC will be offset by improvements in patient-reported outcomes, decreased OOP and healthcare utilization, rendering PC cost-effective in this LIC. These findings may lead to widespread dissemination of an effective, sustainable and cost-saving public PC delivery strategy that would improve the quality of life and death for millions of people.
Clinicaltrials.gov NCT03712436.
低收入国家（LIC）姑息治疗（PC）的患者报告结局和经济方面的研究不足。证明PC的经济价值是其可持续性和指导医疗保健政策的关键。我们在埃塞俄比亚的初步数据表明，对PC的需求广泛、获取困难且自付费用（OOP）高昂。我们怀疑在该国及其他低收入国家，PC不仅可以减轻痛苦，还可以作为一种减贫策略。我们正在亚的斯亚贝巴对新诊断的癌症患者进行一项标准肿瘤护理与标准肿瘤护理加PC的随机对照试验。97名到肿瘤诊所就诊的成年人将按1:1的比例随机分组。接受PC的受试者在入组时和在家中随访时将与PC提供者会面。所有受试者在入组时以及在8±4周和12±4周的肿瘤学随访时通过问卷进行评估。将进行成本后果分析，包括：患者报告的OOP和医疗保健利用情况，后者通过病历判定进行评估。结局将包括非洲姑息治疗协会姑息治疗结局评分的变化、OOP和医疗保健利用情况的变化。我们假设，基于家庭的PC成本将因患者报告结局的改善、OOP和医疗保健利用的减少而得到抵消，从而使PC在这个低收入国家具有成本效益。这些发现可能会导致广泛传播一种有效、可持续且节省成本的公共PC提供策略，这将改善数百万人的生活质量和死亡质量。
Clinicaltrials.gov NCT03712436。
