National Cancer Centre Singapore, Singapore.
Duke-NUS Medical School, Singapore.
Palliat Med. 2021 Sep;35(8):1578-1589. doi: 10.1177/02692163211022957.
The benefit of specialist palliative care for cancer inpatients is established, but the best method to deliver specialist palliative care is unknown.
To compare a consult model versus a co-rounding model; both provide the same content of specialist palliative care to individual patients but differ in the level of integration between palliative care and oncology clinicians.
An open-label, cluster-randomized trial with stepped-wedge design. The primary outcome was hospital length of stay; secondary outcomes were 30-day readmissions and access to specialist palliative care. ClinicalTrials.gov number NCT03330509.
SETTING/PARTICIPANTS: Cancer patients admitted to the oncology inpatient service of an acute hospital in Singapore.
A total of 5681 admissions from December 2017 to July 2019 were included, of which 5295 involved stage 3-4 cancer and 1221 received specialist palliative care review. Admissions in the co-rounding model had a shorter hospital length of stay than those in the consult model by 0.70 days (95%CI -0.04 to 1.45, = 0.065) for all admissions. In the sub-group of stage 3-4 cancer patients, the length of stay was 0.85 days shorter (95%CI 0.05-1.65, = 0.038). In the sub-group of admissions that received specialist palliative care review, the length of stay was 2.62 days shorter (95%CI 0.63-4.61, = 0.010). Hospital readmission within 30 days (OR1.03, 95%CI 0.79-1.35, = 0.822) and access to specialist palliative care (OR1.19, 95%CI 0.90-1.58, = 0.215) were similar between the consult and co-rounding models.
The co-rounding model was associated with a shorter hospital length of stay. Readmissions within 30 days and access to specialist palliative care were similar.
癌症住院患者接受专科姑息治疗的益处已得到证实，但提供专科姑息治疗的最佳方法尚不清楚。
比较咨询模式与共同查房模式；两种模式均为个体患者提供相同内容的专科姑息治疗，但姑息治疗和肿瘤临床医生之间的整合程度不同。
采用开放标签、群组随机试验和逐步楔形设计。主要结局是住院时间；次要结局为 30 天再入院和获得专科姑息治疗的机会。临床试验编号 NCT03330509。
地点/参与者：新加坡一家急性医院肿瘤住院服务部收治的癌症患者。
共纳入 2017 年 12 月至 2019 年 7 月的 5681 例住院患者，其中 5295 例为 3-4 期癌症患者，1221 例接受了专科姑息治疗审查。共同查房模式的住院时间比咨询模式短 0.70 天（95%CI -0.04 至 1.45， = 0.065），所有住院患者均如此。在 3-4 期癌症患者亚组中，住院时间缩短了 0.85 天（95%CI 0.05-1.65， = 0.038）。在接受专科姑息治疗审查的亚组中，住院时间缩短了 2.62 天（95%CI 0.63-4.61， = 0.010）。30 天内再入院（OR1.03，95%CI 0.79-1.35， = 0.822）和获得专科姑息治疗（OR1.19，95%CI 0.90-1.58， = 0.215）在咨询模式和共同查房模式之间相似。
共同查房模式与较短的住院时间相关。30 天内再入院和获得专科姑息治疗的机会相似。
