Division of Geriatric Medicine, University of North Carolina at Chapel Hill (L.C.H., G.S.W.), Chapel Hill, North Carolina, USA; Palliative Care Program, University of North Carolina at Chapel Hill (L.C.H., J.H., G.S.W.), Chapel Hill, North Carolina, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill (L.C.H., K.L.W.), Chapel Hill, North Carolina, USA.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill (L.C.H., K.L.W.), Chapel Hill, North Carolina, USA.
J Pain Symptom Manage. 2021 Sep;62(3):e56-e64. doi: 10.1016/j.jpainsymman.2021.02.032. Epub 2021 Feb 27.
The Collaborative Care Model improves care processes and outcomes but has never been tested for palliative care.
To develop and evaluate a model of collaborative oncology palliative care for Stage IV cancer.
We conducted a pre-post evaluation of Collaborative Oncology Palliative Care (CO-Pal), enrolling patients with Stage IV lung, breast or genitourinary cancers and acute illness hospitalization. CO-Pal has 4 components: 1) oncologist communication skills training; 2) patient tracking; 3) palliative care needs assessment; and 4) care coordination stratified by high vs. low palliative care need. Health record reviews from hospital admission through 60 days provided data on outcomes - goals-of-care discussions (primary outcome), advance care planning, symptom treatment, specialty palliative care and hospice use, and hospital transfers.
We enrolled 256 patients (n = 114 pre and n = 142 post-intervention); 60-day mortality was 32%. Comparing patients pre vs post-intervention, CO-Pal did not increase overall goals-of-care discussions, but did increase advance care planning (48% vs 63%, P = 0.021) and hospice use (19% vs 31%, P = 0.034). CO-Pal did not impact symptom treatment, overall treatment plans, or 60-day hospital transfers. During the intervention phase, high-need vs low-need patients had more goals-of-care discussions (60% vs. 15%, P < 0.001) and more use of specialty palliative care (64% vs 22%, P < 0.001) and hospice (44% vs 16%, P < 0.001).
Collaborative oncology palliative care is efficient and feasible. While it did not increase overall goals-of-care discussions, it was effective to increase overall advance care planning and hospice use for patients with Stage IV cancer.
协作式护理模式可改善护理流程和结果，但尚未针对姑息治疗进行过测试。
为 IV 期癌症患者开发并评估一种协作式肿瘤姑息治疗模式。
我们对协作式肿瘤姑息治疗（CO-Pal）进行了前后评估，纳入了患有 IV 期肺癌、乳腺癌或泌尿生殖系统癌症且有急性疾病住院史的患者。CO-Pal 有 4 个组成部分：1）肿瘤医生沟通技巧培训；2）患者跟踪；3）姑息治疗需求评估；4）根据高、低姑息治疗需求进行护理协调。通过入院至 60 天的病历回顾，提供了关于结局的资料——包括治疗目标讨论（主要结局）、预先护理计划、症状治疗、专科姑息治疗和临终关怀使用情况以及住院转科。
我们纳入了 256 名患者（干预前 114 名，干预后 142 名）；60 天死亡率为 32%。与干预前相比，CO-Pal 并未增加总体治疗目标讨论，但确实增加了预先护理计划（48% vs. 63%，P = 0.021）和临终关怀使用（19% vs. 31%，P = 0.034）。CO-Pal 对症状治疗、总体治疗计划或 60 天住院转科没有影响。在干预阶段，高需求患者与低需求患者相比，有更多的治疗目标讨论（60% vs. 15%，P < 0.001）和更多使用专科姑息治疗（64% vs. 22%，P < 0.001）和临终关怀（44% vs. 16%，P < 0.001）。
协作式肿瘤姑息治疗既高效又切实可行。虽然它没有增加总体治疗目标讨论，但对增加 IV 期癌症患者的总体预先护理计划和临终关怀使用是有效的。
