Greer Joseph A, Temel Jennifer S, El-Jawahri Areej, Rinaldi Simone, Kamdar Mihir, Park Elyse R, Horick Nora K, Pintro Kedie, Rabideau Dustin J, Schwamm Lee, Feliciano Josephine, Chua Isaac, Leventakos Konstantinos, Fischer Stacy M, Campbell Toby C, Rabow Michael W, Zachariah Finly, Hanson Laura C, Martin Sara F, Silveira Maria, Shoemaker Laura, Bakitas Marie, Bauman Jessica, Spoozak Lori, Grey Carl, Blackhall Leslie, Curseen Kimberly, O'Mahony Sean, Smith Melanie M, Rhodes Ramona, Cullinan Amelia, Jackson Vicki
Department of Psychiatry, Massachusetts General Hospital, Boston.
Harvard Medical School, Boston, Massachusetts.
JAMA. 2024 Sep 11;332(14):1153-64. doi: 10.1001/jama.2024.13964.
Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care.
To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non-small cell lung cancer (NSCLC).
DESIGN, SETTING, AND PARTICIPANTS: Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers.
Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits.
Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48.
By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P < .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions.
The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery.
ClinicalTrials.gov Identifier: NCT03375489.
众多研究表明，早期姑息治疗可改善晚期癌症患者及其护理人员的生活质量和其他关键结局，尽管大多数人无法获得这种基于证据的护理模式。
评估通过安全视频与亲自就诊提供早期姑息治疗对晚期非小细胞肺癌（NSCLC）患者生活质量的影响是否相同。
设计、设置和参与者：2018年6月14日至2023年5月4日在美国22个癌症中心进行的随机、多中心、比较有效性试验，纳入1250例确诊晚期NSCLC后12周内的患者和548名护理人员。
参与者从入组时起直至疾病全过程，被随机分为每4周通过视频就诊或在门诊亲自与经过专科培训的姑息治疗临床医生会面。视频就诊组最初进行一次亲自就诊以建立融洽关系，随后进行后续虚拟就诊。
根据癌症治疗-肺癌功能评估问卷，比较视频就诊与亲自进行早期姑息治疗在第24周时对生活质量的影响是否等效（等效界值为±4分；评分范围：0-136分，分数越高表明生活质量越好）。参与者在入组时以及第12、24、36和48周完成研究问卷。
到24周时，参与者（平均年龄65.5岁；54.0%为女性；82.7%为白人）平均进行了4.7次（视频）和4.9次（亲自）早期姑息治疗会诊。两组患者报告的生活质量评分相当（视频组平均分为99.7，亲自就诊组平均分为97.7；差异为2.0[90%CI，0.1-3.9]；等效性检验P=0.04）。视频早期姑息治疗与亲自早期姑息治疗相比，护理人员参与就诊的比例较低（36.6%对49.7%；P<0.001）。研究组在护理人员生活质量、患者应对方式或患者及护理人员对护理的满意度、情绪症状或预后认知方面没有差异。
与亲自提供早期姑息治疗相比，通过虚拟方式提供早期姑息治疗对晚期NSCLC患者的生活质量产生了等效影响，这凸显了通过远程医疗提供这种基于证据的护理模式以改善可及性的巨大潜力。
ClinicalTrials.gov标识符：NCT03375489。
