Does specialty palliative care improve serious illness care experience for people with cancer? Results of a consideRATE questions survey at a National Cancer Center Designated Cancer Center in rural Northern New England.

Abstract

261 Background: Patients' perceived care experience is an important aspect of care quality, particularly during treatment for serious illnesses like cancer. Yet, the effect of specialty palliative care involvement on the care experience of individuals with cancer is underexplored. There is a need for such patient reported quality measures, particularly for patients who may benefit from palliative care. We sought to examine how the presence of palliative care support influenced patient experience. Methods: We surveyed patients and care partners at a National Comprehensive Cancer Network cancer center, The Dartmouth Cancer Center, using the consideRATE questions. consideRATE is a validated patient-reported measure of serious illness experience (PREM) that assesses care of top-ranked elements of serious illness care experience with a Likert-like response scale from very bad (1) to very good (4). We scored mean scores 3.5 or above as “very good.” We collected demographics, type of cancer, identity as a care partner or patient, and patient-reported exposure to the palliative care team, excluding those who were unsure. We performed descriptive statistics, simple and adjusted logistic regressions (controlled for age, gender, race, cancer type, education, income, health insurance, insurance type, and health literacy) to determine to what extent palliative care support affected serious illness care experience scores (consideRATE). Results: We surveyed 244 adults: 114 patients, 128 care partners, and 2 unspecified. One hundred forty-five participants did not receive palliative care; of those, 103 (71%) were women, and 98 (67.6%) were > 55 years. Fifty-six participants received palliative care support; of those, 45 (80.4%) were women, and 38 (67.8%) were > 55 years. Greater than 95% of both groups were white. The most common types of cancer in each group were breast, gastrointestinal, and hematologic. Scores of "very good" on consideRATE were given by 47 (83.9%) of those with palliative services. In adjusted analysis, the OR (odds ratio) of a “very good” consideRATE score was 1.15 for participants who reported palliative care support, compared to those who did not (95% confidence interval 0.8-16.6). Conclusions: In this cohort of rural-residing patients with cancer, whether and to what extent specialty palliative care involvement predicts serious illness care experience scores is unclear. Further investigation of this relationship is required.