Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Support Care Cancer. 2023 Jun 21;31(7):404. doi: 10.1007/s00520-023-07870-9.
Although early palliative care is recommended, resource limitations prevent its routine implementation. We report on the preliminary findings of a mixed methods study involving a randomized controlled trial (RCT) of Symptom screening with Targeted Early Palliative care (STEP) and qualitative interviews.
Adults with advanced solid tumors and an oncologist-estimated prognosis of 6-36 months were randomized to STEP or symptom screening alone. STEP involved symptom screening at each outpatient oncology visit; moderate to severe scores triggered an email to a palliative care nurse, who offered referral to in-person outpatient palliative care. Patient-reported outcomes of quality of life (FACT-G7; primary outcome), depression (PHQ-9), symptom control (ESAS-r-CS), and satisfaction with care (FAMCARE P-16) were measured at baseline and 2, 4, and 6 months. Semi-structured interviews were conducted with a subset of participants.
From Aug/2019 to Mar/2020 (trial halted due to COVID-19 pandemic), 69 participants were randomized to STEP (n = 33) or usual care (n = 36). At 6 months, 45% of STEP arm patients and 17% of screening alone participants had received palliative care (p = 0.009). Nonsignificant differences for all outcomes favored STEP: difference in change scores for FACT-G7 = 1.67 (95% CI: -1.43, 4.77); ESAS-r-CS = -5.51 (-14.29, 3.27); FAMCARE P-16 = 4.10 (-0.31, 8.51); PHQ-9 = -2.41 (-5.02, 0.20). Sixteen patients completed qualitative interviews, describing symptom screening as helpful to initiate communication; triggered referral as initially jarring but ultimately beneficial; and referral to palliative care as timely.
Despite lack of power for this halted trial, preliminary results favored STEP and qualitative results demonstrated acceptability. Findings will inform an RCT of combined in-person and virtual STEP.
尽管建议早期进行姑息治疗，但资源限制使其无法常规实施。我们报告了一项混合方法研究的初步结果，该研究包括一项随机对照试验（RCT），即采用症状筛查联合针对性早期姑息治疗（STEP）对患者进行评估，并进行了定性访谈。
研究纳入了预计生存期为 6-36 个月的晚期实体瘤成年患者，将其随机分配至 STEP 组或仅行症状筛查组。STEP 组在每次门诊肿瘤就诊时进行症状筛查；中重度评分会触发向姑息护理护士发送电子邮件，由其提供门诊姑息护理转介。主要结局为患者报告的生活质量（FACT-G7）、抑郁（PHQ-9）、症状控制（ESAS-r-CS）和护理满意度（FAMCARE P-16）的变化，在基线和 2、4、6 个月时进行评估。对部分参与者进行了半结构化访谈。
2019 年 8 月至 2020 年 3 月（因 COVID-19 大流行而停止试验），共纳入 69 名患者，随机分配至 STEP 组（n=33）或仅行症状筛查组（n=36）。在 6 个月时，STEP 组有 45%的患者和仅行症状筛查组 17%的患者接受了姑息治疗（p=0.009）。所有结局的变化评分均倾向于 STEP 组，差异无统计学意义：FACT-G7 的变化差值为 1.67（95%CI：-1.43，4.77）；ESAS-r-CS 为-5.51（-14.29，3.27）；FAMCARE P-16 为 4.10（-0.31，8.51）；PHQ-9 为-2.41（-5.02，0.20）。16 名患者完成了定性访谈，他们描述症状筛查有助于开启沟通；触发转介时最初感到不适，但最终受益；并认为姑息治疗的转介及时。
尽管这项已停止的试验缺乏效能，但初步结果倾向于 STEP 组，定性结果表明其可接受性。这些结果将为 STEP 联合门诊和虚拟姑息治疗的 RCT 提供信息。
